Healthcare Provider Details

I. General information

NPI: 1295284347
Provider Name (Legal Business Name): ALISON NEWELL YOUNG CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 SUMMERFIELD RD
SANTA ROSA CA
95405-5239
US

IV. Provider business mailing address

583 SUMMERFIELD RD
SANTA ROSA CA
95405-5239
US

V. Phone/Fax

Practice location:
  • Phone: 714-454-5851
  • Fax:
Mailing address:
  • Phone: 714-454-5851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number95094624
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMW235809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: