Healthcare Provider Details

I. General information

NPI: 1295730984
Provider Name (Legal Business Name): LYNNA R. YOUNG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55585 29 PALMS HWY
YUCCA VALLEY CA
92284-2505
US

IV. Provider business mailing address

2325 E JOYCE DR
PALM SPRINGS CA
92262-2462
US

V. Phone/Fax

Practice location:
  • Phone: 760-228-3366
  • Fax: 760-228-3369
Mailing address:
  • Phone: 760-416-0504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP10058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: