MEDICARE: MARY C YOUNG APRN

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	363LN0000X	Neonatal Nurse Practitioner	000953	CT
2	363LP0200X	Pediatric Nurse Practitioner	000953	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063487106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY C YOUNG APRN

Provider Business Mailing Address
First Line	:	114 WOODLAND STREET
Second Line	:	NEONATAL INTENSIVE CARE
City	:	HARTFORD
State	:	CT
Zip	:	06105
Country	:	US
Telephone Number	:	860-714-4404
Fax Number	:	860-714-8218

Provider Business Practice Location Address
First Line	:	1000 ASYLUM AVE STE 2109A
Second Line	:	NEONATAL INTENSIVE CARE
City	:	HARTFORD
State	:	CT
Zip	:	06105-1719
Country	:	US
Telephone Number	:	860-714-6581
Fax Number	:

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	02/13/2023

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Directions to “ MARY C YOUNG APRN” Practice Location

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