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General NPI Number Information
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NPI Number | 1770081648
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Entity Type | Individual
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Provider Name | ALEXANDER LAWRENCE YOUNG
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Gender | Male
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Dates
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Enumeration Date | 01/25/2018
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 165 W CENTER ST
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City | MARION
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State | OH
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Zip | 43302-3742
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Country | US
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Telephone | 740-692-4410
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Fax |
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Provider Business Mailing Address
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Address Line | 505 E SANDUSKY AVE
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-2440
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.022257
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License Number State | OH
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