Healthcare Provider Details

I. General information

NPI: 1073089439
Provider Name (Legal Business Name): MARYN LYNNA YOUNG FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIN LYNNA YOUNG-DELP

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 06/20/2022
Certification Date: 06/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 4TH ST S
FARGO ND
58103-1914
US

IV. Provider business mailing address

73372 ADOBE SPRINGS DR
PALM DESERT CA
92260-1143
US

V. Phone/Fax

Practice location:
  • Phone: 701-476-7200
  • Fax:
Mailing address:
  • Phone: 760-898-5806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009992
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number829828
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR46797
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: