Healthcare Provider Details

I. General information

NPI: 1265718142
Provider Name (Legal Business Name): CAITLIN MARIE YOUNG CNM, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAITLIN MARIE WAIT

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

968 GRAND AVE.
ST. PAUL MN
55105
US

IV. Provider business mailing address

7724 NORTH STREET
ST. LOUIS PARK MN
55426
US

V. Phone/Fax

Practice location:
  • Phone: 651-895-2520
  • Fax:
Mailing address:
  • Phone: 720-273-8502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCNM-170014
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCNM
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: