MEDICARE: LUCHIA YOUNG PMHNP-BC, FNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP5602	AZ
2	363LF0000X	Family Nurse Practitioner	AP3446	AZ

General Provider Information

NPI Number	:	1730286253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCHIA YOUNG PMHNP-BC, FNP-BC

Provider Business Mailing Address
First Line	:	18247 N TOYA ST
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138-2905
Country	:	US
Telephone Number	:	832-964-4022
Fax Number	:	347-960-4805

Provider Business Practice Location Address
First Line	:	18247 N TOYA ST
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138-2905
Country	:	US
Telephone Number	:	832-964-4022
Fax Number	:	347-960-4805

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

Provider Enumeration Date	:	09/19/2006
Last Update Date	:	10/08/2020

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