Provider Demographics
NPI:1124290226
Name:YOUNG, STARLA G (LPN)
Entity type:Individual
Prefix:
First Name:STARLA
Middle Name:G
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-4431
Mailing Address - Country:US
Mailing Address - Phone:918-682-8407
Mailing Address - Fax:
Practice Address - Street 1:2719 E SHAWNEE RD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1533
Practice Address - Country:US
Practice Address - Phone:918-687-1039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0025934164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse