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General NPI Number Information
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NPI Number | 1417411646
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Entity Type | Individual
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Provider Name | LAURA YOUNG RD
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Gender | Female
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Dates
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Enumeration Date | 01/22/2019
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 1024 S LEMAY AVE
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City | FORT COLLINS
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State | CO
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Zip | 80524-3929
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Country | US
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Telephone | 970-495-8205
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Fax |
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Provider Business Mailing Address
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Address Line | 6801 W 20TH ST
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City | GREELEY
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State | CO
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Zip | 80634-9637
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Country | US
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Telephone | 970-378-8000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 984293
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License Number State | CO
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