Provider Demographics
NPI:1154550259
Name:YOUNG, CARRIE JEAN (RN, CNM, APRN)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:JEAN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RN, CNM, APRN
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:JEAN YOUNG
Other - Last Name:BREADON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1123 SAINT CROIX HTS
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1409
Mailing Address - Country:US
Mailing Address - Phone:949-395-7336
Mailing Address - Fax:
Practice Address - Street 1:1100 BERGSLIEN ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-2600
Practice Address - Country:US
Practice Address - Phone:715-684-1111
Practice Address - Fax:715-684-1119
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN862548163W00000X
MN387363LX0001X
MNCNM387367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology