Provider Demographics
NPI:1730438219
Name:YOUNG, VANESSA ANN (LPN)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4223 W. DOUGLAS AVE.
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3528
Mailing Address - Country:US
Mailing Address - Phone:414-393-0199
Mailing Address - Fax:
Practice Address - Street 1:4223 W. DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-3528
Practice Address - Country:US
Practice Address - Phone:414-393-0199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI302759-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse