Provider Demographics
NPI:1679569701
Name:YOUNG, JANE N (CRNP MSN)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:N
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CRNP MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 N CURTIS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1300
Mailing Address - Country:US
Mailing Address - Phone:208-377-5166
Mailing Address - Fax:208-375-0599
Practice Address - Street 1:1075 N CURTIS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1300
Practice Address - Country:US
Practice Address - Phone:208-377-5166
Practice Address - Fax:208-375-0599
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP71A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010016730OtherBLUE SHIELD
IDNP414OtherBLUE CROSS/TRUE BLUE
IDNP414OtherBLUE CROSS/TRUE BLUE
S61651Medicare UPIN