1942250261 NPI number — MRS. WILDA MILLER YOUNG LPT

Table of content: MRS. WILDA MILLER YOUNG LPT (NPI 1942250261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942250261 NPI number — MRS. WILDA MILLER YOUNG LPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
WILDA
Provider Middle Name:
MILLER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942250261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2009 DALTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27408-5825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-574-1506
Provider Business Mailing Address Fax Number:
336-370-1016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1313 CAROLINA ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27401-6000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-275-6380
Provider Business Practice Location Address Fax Number:
336-275-6381
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  8508 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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