Provider Demographics
NPI:1144680430
Name:YOUNG, MICHELLE L (APRN)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:GINGRAS-HINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:148 ONEIL RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1546
Mailing Address - Country:US
Mailing Address - Phone:860-309-6857
Mailing Address - Fax:
Practice Address - Street 1:131 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-2929
Practice Address - Country:US
Practice Address - Phone:203-729-0755
Practice Address - Fax:203-729-0797
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6478363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner