MEDICARE: MRS. ANN KURENE YOUNG R.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1004X	Pediatric Nutrition Registered Dietitian

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	862855	OTHER		REGISTERED DIETITIAN

General Provider Information

NPI Number	:	1164643516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANN KURENE YOUNG R.D.

Provider Business Mailing Address
First Line	:	14124 W DARTMOUTH AVE
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-5440
Country	:	US
Telephone Number	:	303-475-2102
Fax Number	:

Provider Business Practice Location Address
First Line	:	1780 S BELLAIRE ST STE 515
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-4326
Country	:	US
Telephone Number	:	303-759-5316
Fax Number	:	303-759-5320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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