Healthcare Provider Details

I. General information

NPI: 1982278867
Provider Name (Legal Business Name): GERI YOUNG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14902 WELCOME LN
HOUSTON TX
77014-1406
US

IV. Provider business mailing address

14902 WELCOME LN
HOUSTON TX
77014-1406
US

V. Phone/Fax

Practice location:
  • Phone: 586-718-4320
  • Fax:
Mailing address:
  • Phone: 586-718-4320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARIANA MANESCU
Title or Position: OWNER
Credential: NP
Phone: 586-718-4320