Healthcare Provider Details

I. General information

NPI: 1841520889
Provider Name (Legal Business Name): ELIZABETH ANNE YOUNG REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 STATE ST
SPRINGFIELD MA
01109-4104
US

IV. Provider business mailing address

622 STATE ST
SPRINGFIELD MA
01109-4104
US

V. Phone/Fax

Practice location:
  • Phone: 413-439-1223
  • Fax: 413-732-4720
Mailing address:
  • Phone: 413-439-1223
  • Fax: 413-732-4720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number106978
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number106978
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: