MEDICARE: SYDNEY T YOUENS ACNP

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	363L00000X	Nurse Practitioner	5003974	NC

General Provider Information

NPI Number	:	1790956704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY T YOUENS ACNP

Provider Business Mailing Address
First Line	:	1830 S HAWTHORNE RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-4014
Country	:	US
Telephone Number	:	336-448-2427
Fax Number	:	336-765-2869

Provider Business Practice Location Address
First Line	:	500 SHEPHERD ST
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1633
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:

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

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	03/27/2020

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