Basic Information
| Provider Information | |||||||||
| NPI: | 1932871712 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 648 RITTENHOUSE PL | ||||||||
| Address2: | |||||||||
| City: | TELFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189692236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157233224 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1605 N CEDAR CREST BLVD | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181042351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109731466 | ||||||||
| FaxNumber: | 6109731449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2021 | ||||||||
| LastUpdateDate: | 09/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP022892 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.