Provider Demographics
NPI:1689423329
Name:YOUNG, JEREMY JOSEPH
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:JOSEPH
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 E MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-5415
Mailing Address - Country:US
Mailing Address - Phone:509-570-4267
Mailing Address - Fax:
Practice Address - Street 1:1224 W RIVERSIDE AVE APT 1007
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1125
Practice Address - Country:US
Practice Address - Phone:509-328-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider