MEDICARE: VIVIAN JOSEPHINE YOUNG FNP

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
1	363LF0000X	Family Nurse Practitioner	495017	CA
2	363L00000X	Nurse Practitioner	NP11647	CA

General Provider Information

NPI Number	:	1043395528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN JOSEPHINE YOUNG FNP

Provider Business Mailing Address
First Line	:	6730 N WEST AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-4301
Country	:	US
Telephone Number	:	559-439-3000
Fax Number	:	559-439-3004

Provider Business Practice Location Address
First Line	:	6730 N WEST AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-4301
Country	:	US
Telephone Number	:	559-439-3000
Fax Number	:	559-439-3004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/02/2023

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