Provider Demographics
NPI:1861998270
Name:YOUNG, SAMANTHA JUNE (NP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JUNE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17021 LAKESIDE DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130
Mailing Address - Country:US
Mailing Address - Phone:402-592-9000
Mailing Address - Fax:402-592-1631
Practice Address - Street 1:17021 LAKESIDE DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130
Practice Address - Country:US
Practice Address - Phone:402-592-9000
Practice Address - Fax:402-592-1631
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE2050363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner