Provider Demographics
NPI:1114034238
Name:YOUNG, MARY ELIZABETH (ARNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:YOUNG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 BUTTERNUT LANE
Mailing Address - Street 2:PO BOX 123
Mailing Address - City:TAFTSVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05073
Mailing Address - Country:US
Mailing Address - Phone:831-594-3818
Mailing Address - Fax:
Practice Address - Street 1:70 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-7061
Practice Address - Country:US
Practice Address - Phone:802-295-1868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH014489-23-05363LA2200X
VT101.0022507363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health