Healthcare Provider Details

I. General information

NPI: 1922061621
Provider Name (Legal Business Name): YOUNG-HEE SONG ANP, CHN-CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR BLDG 7500
FORT CARSON CO
80913-4603
US

IV. Provider business mailing address

1650 COCHRANE CIR
COLORADO SPRINGS CO
80913-4613
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-6414
  • Fax: 719-526-7181
Mailing address:
  • Phone: 719-526-7632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number431528-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number164236
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number164236
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: