1669182598 NPI number — PAULA LEE MCNEIL YOUNG PMHNP-BC

Table of content: PAULA LEE MCNEIL YOUNG PMHNP-BC (NPI 1669182598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669182598 NPI number — PAULA LEE MCNEIL YOUNG PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
PAULA
Provider Middle Name:
LEE MCNEIL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC
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:
1669182598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 28 3/4 RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND JUNCTION
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81501-5016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-683-7223
Provider Business Mailing Address Fax Number:
970-683-7160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2802 GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENWOOD SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81601-4428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-945-2583
Provider Business Practice Location Address Fax Number:
970-928-8852
Provider Enumeration Date:
12/01/2022

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: 363LP0808X , with the licence number:  APN.0998167-NP , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RXN.0107178-NP . This is a "CO DEPARTMENT OF REGULATORY AGENCIES; DIVISION OF PROFESSIONS AND OCCUPATIONS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: RN.0168095 . This is a "CO DEPARTMENT OF REGULATORY AGENCIES; DIVISION OF PROFESSIONS AND OCCUPATIONS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: APN.0998167-NP . This is a "CO DEPARTMENT OF REGULATORY AGENCIES; DIVISION OF PROFESSIONS AND OCCUPATIONS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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