Healthcare Provider Details

I. General information

NPI: 1497224232
Provider Name (Legal Business Name): DINA MARIE YOUNG LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2018
Last Update Date: 11/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 SILVERTON RD NE
SALEM OR
97301-0100
US

IV. Provider business mailing address

3816 GLENWOOD LOOP SE
SALEM OR
97317-5639
US

V. Phone/Fax

Practice location:
  • Phone: 503-588-5358
  • Fax: 503-361-2688
Mailing address:
  • Phone: 503-580-2955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number20171942LPN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: