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NPI Code Detail

MEDICARE: LISA YOUNG

MEDICARE: LISA YOUNG
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
1363LF0000XFamily Nurse Practitioner209-001713IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10325623-22OTHERILANCC

General Provider Information

NPI Number : 1801979000
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA YOUNG
Provider Business Mailing Address
First Line : 161 WASHINGTON ST
Second Line : EIGHT TOWER BRIDGE, SUITE 1400
City : CONSHOHOCKEN
State : PA
Zip : 19428-2083
Country : US
Telephone Number : 866-825-3227
Fax Number : 484-351-3800
Provider Business Practice Location Address
First Line : 11 E 75TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60619-1601
Country : US
Telephone Number : 866-825-3227
Fax Number : 484-351-3800
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 10/22/2012

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Directions to “ LISA YOUNG ” Practice Location

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