1376312983 NPI number — MRS. DARNELL ELIZABETH YOUNG OTA

Table of content: MRS. DARNELL ELIZABETH YOUNG OTA (NPI 1376312983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376312983 NPI number — MRS. DARNELL ELIZABETH YOUNG OTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
DARNELL
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORROW
Provider Other First Name:
DARNELL
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376312983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
905 1ST ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELROSE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56352-1411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
132-036-0588
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STARBUCK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
58381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-360-5880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2023

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: 224Z00000X , with the licence number:  201074 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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