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General NPI Number Information
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NPI Number | 1841805561
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Entity Type | Individual
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Provider Name | ALYSSA ROSE YOUNG LPN
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Gender | Female
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 25 CHAUCER CIR
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City | BALDWINSVILLE
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State | NY
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Zip | 13027-8254
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Country | US
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Telephone | 315-350-1947
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Fax |
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Provider Business Mailing Address
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Address Line | 26 CANDLEWOOD GDNS
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City | BALDWINSVILLE
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State | NY
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Zip | 13027-2603
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Country | US
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Telephone | 203-957-5165
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 339
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License Number State | NY
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