Healthcare Provider Details

I. General information

NPI: 1043502073
Provider Name (Legal Business Name): BETHANY A YOUNG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 E INDIAN TRL
AURORA IL
60505-1600
US

IV. Provider business mailing address

601 KAREN DR
SOMONAUK IL
60552-9655
US

V. Phone/Fax

Practice location:
  • Phone: 630-966-4290
  • Fax:
Mailing address:
  • Phone: 815-690-5635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number041354853
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: