Healthcare Provider Details

I. General information

NPI: 1619957214
Provider Name (Legal Business Name): WILLIAM ALLEN YOUNG RN, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 827 BOX 100
FPO AE
09617
IT

IV. Provider business mailing address

PSC 827 BOX 100
FPO AE
09617
IT

V. Phone/Fax

Practice location:
  • Phone: 81-811-5559
  • Fax:
Mailing address:
  • Phone: 81-811-5559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704214351
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: