Basic Information
| Provider Information | |||||||||
| NPI: | 1477852747 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 442 WEST HIGH STREET | ||||||||
| Address2: | MIDWEST COMMUNITY HEALTH ASSOCIATES | ||||||||
| City: | BRYAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196364517 | ||||||||
| FaxNumber: | 4196366438 | ||||||||
| Practice Location | |||||||||
| Address1: | 442 WEST HIGH STREET | ||||||||
| Address2: | MIDWEST COMMUNITY HEALTH ASSOCIATES | ||||||||
| City: | BRYAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196364517 | ||||||||
| FaxNumber: | 4196366438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2011 | ||||||||
| LastUpdateDate: | 03/25/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 50.003262 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.