MEDICARE: MS. JANE YOUNG FNP

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	363LF0000X	Family Nurse Practitioner	F330121-1	NY

General Provider Information

NPI Number	:	1528096245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANE YOUNG FNP

Provider Business Mailing Address
First Line	:	9 ELWYN LN
Second Line	:
City	:	WOODSTOCK
State	:	NY
Zip	:	12498-1301
Country	:	US
Telephone Number	:	845-679-7876
Fax Number	:	845-679-3324

Provider Business Practice Location Address
First Line	:	9 ELWYN LN
Second Line	:
City	:	WOODSTOCK
State	:	NY
Zip	:	12498-1301
Country	:	US
Telephone Number	:	845-679-7876
Fax Number	:	845-679-3324

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/08/2007

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