Healthcare Provider Details

I. General information

NPI: 1659750537
Provider Name (Legal Business Name): VIRGINIA RUTH YOUNG PCNS- BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2015
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

IV. Provider business mailing address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-5686
  • Fax:
Mailing address:
  • Phone: 214-456-5686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License NumberAP119488
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: