Healthcare Provider Details

I. General information

NPI: 1154550259
Provider Name (Legal Business Name): CARRIE JEAN YOUNG RN, CNM, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE JEAN YOUNG BREADON RN

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 01/11/2022
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BERGSLIEN ST
BALDWIN WI
54002-2600
US

IV. Provider business mailing address

1123 SAINT CROIX HTS
HUDSON WI
54016-1409
US

V. Phone/Fax

Practice location:
  • Phone: 715-684-1111
  • Fax: 715-684-1119
Mailing address:
  • Phone: 949-395-7336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN862548
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number387
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM387
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: