Healthcare Provider Details

I. General information

NPI: 1851645014
Provider Name (Legal Business Name): CHRISTI ANN YOUNG RN, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12725 SW 66TH AVE STE 207
PORTLAND OR
97223-2548
US

IV. Provider business mailing address

11801 SE MCGILLIVRAY BLVD
VANCOUVER WA
98683-5207
US

V. Phone/Fax

Practice location:
  • Phone: 360-335-7146
  • Fax:
Mailing address:
  • Phone: 360-335-7146
  • Fax: 770-723-8787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00070176
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number00104269
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: