Healthcare Provider Details

I. General information

NPI: 1215708003
Provider Name (Legal Business Name): COURTNEY LOUISE YOUNG PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 UNION ST STE 145
BANGOR ME
04401-3073
US

IV. Provider business mailing address

80 PERKINS AVE APT 2
OLD TOWN ME
04468-1746
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-9595
  • Fax:
Mailing address:
  • Phone: 315-528-5975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: