Healthcare Provider Details

I. General information

NPI: 1932943461
Provider Name (Legal Business Name): MARIAMA YOUNG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5435 W PIKE PLAZA RD
INDIANAPOLIS IN
46254-3010
US

IV. Provider business mailing address

5435 W PIKE PLAZA RD
INDIANAPOLIS IN
46254-3010
US

V. Phone/Fax

Practice location:
  • Phone: 317-754-4565
  • Fax: 317-583-2986
Mailing address:
  • Phone: 317-754-4565
  • Fax: 317-583-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number28235553A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: