Provider Demographics
NPI:1114710092
Name:YOUNG, EVAN P
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:P
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 1:10770 HOOPER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GLOUSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45732-9247
Mailing Address - Country:US
Mailing Address - Phone:740-590-3780
Mailing Address - Fax:
Practice Address - Street 1:10770 HOOPER RIDGE RD
Practice Address - Street 2:
Practice Address - City:GLOUSTER
Practice Address - State:OH
Practice Address - Zip Code:45732-9247
Practice Address - Country:US
Practice Address - Phone:740-590-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker