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NPI Code Detail

MEDICARE: MRS. JACQUELINE MARIE YOUNG CRNA

MEDICARE: MRS. JACQUELINE MARIE YOUNG CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist35003OH

General Provider Information

NPI Number : 1013246172
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JACQUELINE MARIE YOUNG CRNA
Provider Business Mailing Address
First Line : 3229 BURNET AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45229-3018
Country : US
Telephone Number : 513-872-6310
Fax Number :
Provider Business Practice Location Address
First Line : 3229 BURNET AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45229-3018
Country : US
Telephone Number : 513-872-6310
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2009
Last Update Date : 12/18/2009

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