Provider Demographics
NPI:1831755164
Name:YOUNG, JOAN MARIE
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21501 LANGFORD AVE
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:MN
Mailing Address - Zip Code:55352-9358
Mailing Address - Country:US
Mailing Address - Phone:952-492-2230
Mailing Address - Fax:
Practice Address - Street 1:21501 LANGFORD AVE
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:MN
Practice Address - Zip Code:55352-9358
Practice Address - Country:US
Practice Address - Phone:952-492-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)