Healthcare Provider Details

I. General information

NPI: 1043663404
Provider Name (Legal Business Name): ANNA MARIE YOUNG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 N CLARE AVE
HARRISON MI
48625-8250
US

IV. Provider business mailing address

PO BOX 817
HARRISON MI
48625-0817
US

V. Phone/Fax

Practice location:
  • Phone: 989-539-2141
  • Fax: 989-539-2143
Mailing address:
  • Phone: 989-539-2141
  • Fax: 989-539-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4704322974
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: