Healthcare Provider Details

I. General information

NPI: 1073564977
Provider Name (Legal Business Name): PATRICIA YOUNG CERTIFIED NURSE MIDW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 HERRICK ST STE 3002
BEVERLY MA
01915
US

IV. Provider business mailing address

83 HERRICK ST STE 3002
BEVERLY MA
01915
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-4800
  • Fax: 978-232-5772
Mailing address:
  • Phone: 978-927-4800
  • Fax: 978-232-5772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number98157
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: