Provider Demographics
NPI:1770899015
Name:YOUNG, NICOLE ANN (CPM/LM)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CPM/LM
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:ONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPM/LM
Mailing Address - Street 1:2041 WATERBURY DR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-9770
Mailing Address - Country:US
Mailing Address - Phone:330-807-0320
Mailing Address - Fax:
Practice Address - Street 1:2041 WATERBURY DR
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-9770
Practice Address - Country:US
Practice Address - Phone:330-807-0320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2017-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM01427R176B00000X
SCLMW-038176B00000X
OH010900073747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No176B00000XOther Service ProvidersMidwife