Provider Demographics
NPI:1730615030
Name:YOUNG, DEBORAH LYNN (APRN, FNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:L
Other - Last Name:BERTRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP
Mailing Address - Street 1:N2950 STATE RD 67
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-2655
Mailing Address - Country:US
Mailing Address - Phone:262-245-4990
Mailing Address - Fax:262-245-2248
Practice Address - Street 1:N2950 STATE ROAD 67
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-2655
Practice Address - Country:US
Practice Address - Phone:262-245-0535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI143335-30163W00000X
WI7664-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1730615030OtherBCBSWI
ILAPPROVEDOtherBCBS IL PPO
ILF400420519OtherIL MEDICARE
WI1730615030Medicaid
WIK400399977OtherWI MEDICARE
WI700332OtherMERCYCARE INSURANCE