Provider Demographics
NPI:1053701441
Name:YOUNG, COLLEEN (BSN, RN)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 N DELAWARE AVE STE 300D
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-4335
Mailing Address - Country:US
Mailing Address - Phone:215-287-2114
Mailing Address - Fax:267-773-4430
Practice Address - Street 1:1080 N DELAWARE AVE STE 300D
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-4335
Practice Address - Country:US
Practice Address - Phone:215-287-2114
Practice Address - Fax:267-773-4430
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN652555163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse