Healthcare Provider Details

I. General information

NPI: 1396213070
Provider Name (Legal Business Name): MICHELE YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2018
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 S SANTA BARBARA ST
DEMING NM
88030-5361
US

IV. Provider business mailing address

1995 ASH ST SW
DEMING NM
88030-0793
US

V. Phone/Fax

Practice location:
  • Phone: 575-936-4227
  • Fax:
Mailing address:
  • Phone: 575-494-0371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: