MEDICARE: MRS. KATHLEEN I YOUNG

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	164W00000X	Licensed Practical Nurse	311512	NY

General Provider Information

NPI Number	:	1184083578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN I YOUNG

Provider Business Mailing Address
First Line	:	140 FLORENTIA LN E
Second Line	:
City	:	CORNING
State	:	NY
Zip	:	14830-3278
Country	:	US
Telephone Number	:	607-936-8834
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 COLLEGE AVE
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-1156
Country	:	US
Telephone Number	:	607-733-4504
Fax Number	:

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

Provider Enumeration Date	:	02/15/2016
Last Update Date	:	02/15/2016

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