Healthcare Provider Details

I. General information

NPI: 1275257321
Provider Name (Legal Business Name): ALECIA MARIE YOUNG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 WILLIAM ST
LYONS NY
14489-1550
US

IV. Provider business mailing address

98 WILLIAM ST
LYONS NY
14489-1550
US

V. Phone/Fax

Practice location:
  • Phone: 315-946-2200
  • Fax: 315-946-2249
Mailing address:
  • Phone: 315-946-2200
  • Fax: 315-946-2249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number677010
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: