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NPI Code Detail

MEDICARE: CRYSTAL DIONNA YOUNG LPN

MEDICARE:   CRYSTAL DIONNA YOUNG  LPN
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
1164W00000XLicensed Practical NursePN.132289-M-IVOH

General Provider Information

NPI Number : 1902107188
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL DIONNA YOUNG LPN
Provider Business Mailing Address
First Line : 1526 BELMAR RD
Second Line :
City : EAST CLEVELAND
State : OH
Zip : 44118-1123
Country : US
Telephone Number : 216-322-2152
Fax Number :
Provider Business Practice Location Address
First Line : 1526 BELMAR RD
Second Line :
City : EAST CLEVELAND
State : OH
Zip : 44118-1123
Country : US
Telephone Number : 216-322-2152
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2010
Last Update Date : 11/04/2010

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Directions to “ CRYSTAL DIONNA YOUNG LPN” Practice Location

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