Healthcare Provider Details

I. General information

NPI: 1629349998
Provider Name (Legal Business Name): DANAE LEAH YOUNG N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 WISHARD BLVD
INDIANAPOLIS IN
46202-2872
US

IV. Provider business mailing address

PO BOX 44730
INDIANAPOLIS IN
46244-0730
US

V. Phone/Fax

Practice location:
  • Phone: 317-692-2333
  • Fax: 317-278-9918
Mailing address:
  • Phone: 317-274-2928
  • Fax: 317-278-9918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number71003846A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: