MEDICARE: MS. PATRICIA YOUNG RN APN C

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	26NN05637900	NJ
2	163WL0100X	Lactation Consultant (Registered Nurse)		NJ

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	:	1881682417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA YOUNG RN APN C

Provider Business Mailing Address
First Line	:	10 FERRO DR
Second Line	:
City	:	SEWELL
State	:	NJ
Zip	:	08080-9314
Country	:	US
Telephone Number	:	856-582-1308
Fax Number	:	609-345-2105

Provider Business Practice Location Address
First Line	:	2829 ATLANTIC AVE
Second Line	:
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-6325
Country	:	US
Telephone Number	:	609-348-4813
Fax Number	:	609-345-2105

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	07/21/2022

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