Healthcare Provider Details

I. General information

NPI: 1679294144
Provider Name (Legal Business Name): LAUREN V YOUNG AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W THOMAS RD STE 500
PHOENIX AZ
85013-4220
US

IV. Provider business mailing address

500 W THOMAS RD STE 500
PHOENIX AZ
85013-4220
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-4000
  • Fax: 602-406-6498
Mailing address:
  • Phone: 602-406-4000
  • Fax: 602-406-6498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberRNP280297
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number280297
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: