Basic Information
| Provider Information | |||||||||
| NPI: | 1871509067 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNGBLOOD | ||||||||
| FirstName: | DORIAN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 TRENTON ROAD | ||||||||
| Address2: | DEBORAH HEART AND LUNG CENTER | ||||||||
| City: | BROWNS MILLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08048 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 TRENTON ROAD | ||||||||
| Address2: | DEBORAH HEART AND LUNG CENTER | ||||||||
| City: | BROWNS MILLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098936611 | ||||||||
| FaxNumber: | 6097350415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 04/06/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 11837200 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.