Healthcare Provider Details

I. General information

NPI: 1083945562
Provider Name (Legal Business Name): LEILANI J YOUNKIN CLIN. LAB SCIENTIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 BLACK COAL DRIVE
FT WASHAKIE WY
82514
US

IV. Provider business mailing address

14 GREAT PLAINS RD
ARAPAHOE WY
82510
US

V. Phone/Fax

Practice location:
  • Phone: 307-332-7692
  • Fax:
Mailing address:
  • Phone: 307-856-9281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number62884
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: