Healthcare Provider Details

I. General information

NPI: 1952591232
Provider Name (Legal Business Name): DONNIS DEANN YOUNG LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7904 FORCE AVE
CLEVELAND OH
44105-5810
US

IV. Provider business mailing address

7904 FORCE AVE
CLEVELAND OH
44105-5810
US

V. Phone/Fax

Practice location:
  • Phone: 216-883-3999
  • Fax:
Mailing address:
  • Phone: 216-883-3999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number112230
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: