Provider Demographics
NPI:1861766461
Name:YOUNG, JENICE JANELLE (RN)
Entity type:Individual
Prefix:MRS
First Name:JENICE
Middle Name:JANELLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JENICE
Other - Middle Name:JANELLE
Other - Last Name:HICKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4 WHITE BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-1142
Mailing Address - Country:US
Mailing Address - Phone:518-798-3567
Mailing Address - Fax:
Practice Address - Street 1:4 WHITE BIRCH LN
Practice Address - Street 2:
Practice Address - City:GANSEVOORT
Practice Address - State:NY
Practice Address - Zip Code:12831-1142
Practice Address - Country:US
Practice Address - Phone:518-798-3567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY559044-1163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine