=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730615030
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH LYNN YOUNG APRN, FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2017
-----------------------------------------------------
Last Update Date | 12/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | N2950 STATE ROAD 67
-----------------------------------------------------
City | LAKE GENEVA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53147-2655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-245-0535
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | N2950 STATE RD 67
-----------------------------------------------------
City | LAKE GENEVA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53147-2655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-245-4990
-----------------------------------------------------
Fax | 262-245-2248
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 143335-30
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 7664-33
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------