Healthcare Provider Details

I. General information

NPI: 1891321543
Provider Name (Legal Business Name): CINDY RAE YOUNG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 11/27/2023
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 RIDGEWATER DR STE A
POLSON MT
59860-8977
US

IV. Provider business mailing address

116 ORCHARD PARK LN
POLSON MT
59860-7222
US

V. Phone/Fax

Practice location:
  • Phone: 406-883-3200
  • Fax:
Mailing address:
  • Phone: 406-249-9392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-158410
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: