MEDICARE: DARYL A YOUNG NP

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	6157-124	AK

General Provider Information

NPI Number	:	1730122946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYL A YOUNG NP

Provider Business Mailing Address
First Line	:	3611 KNIK AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99517-1045
Country	:	US
Telephone Number	:	907-868-3116
Fax Number	:

Provider Business Practice Location Address
First Line	:	3611 KNIK AVENUE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99517-1045
Country	:	US
Telephone Number	:	907-868-3116
Fax Number	:

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/08/2007

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