Healthcare Provider Details

I. General information

NPI: 1093220857
Provider Name (Legal Business Name): WENDY LOU YOUNG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2017
Last Update Date: 12/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

11449 278TH ST
CHISAGO CITY MN
55013-9722
US

V. Phone/Fax

Practice location:
  • Phone: 612-725-2000
  • Fax:
Mailing address:
  • Phone: 651-270-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number099817-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: