Healthcare Provider Details

I. General information

NPI: 1124339502
Provider Name (Legal Business Name): LA YOUNG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S 16TH ST SUITE 330
LINCOLN NE
68502-3796
US

IV. Provider business mailing address

2222 S 16TH ST SUITE 330
LINCOLN NE
68502-3796
US

V. Phone/Fax

Practice location:
  • Phone: 402-474-1511
  • Fax: 402-474-1611
Mailing address:
  • Phone: 402-474-1511
  • Fax: 402-474-1611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number110069
License Number StateNE

VIII. Authorized Official

Name: LISA ANNE YOUNG
Title or Position: NURSE PRACTIONER
Credential: MSN, APRN, BC
Phone: 402-474-1511