MEDICARE: MARCIA 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
1	163WS0200X	School Registered Nurse	5023631	NY

General Provider Information

NPI Number	:	1811208176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA YOUNG

Provider Business Mailing Address
First Line	:	400 FENIMORE ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-5906
Country	:	US
Telephone Number	:	917-692-5907
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 FENIMORE ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-5906
Country	:	US
Telephone Number	:	917-692-5907
Fax Number	:

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

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	07/01/2010

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