Provider Demographics
NPI:1154965986
Name:YOUNG, SHEENA SATOKO (FNP)
Entity type:Individual
Prefix:MRS
First Name:SHEENA
Middle Name:SATOKO
Last Name:YOUNG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1986 W HAYDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-7412
Mailing Address - Country:US
Mailing Address - Phone:208-762-7760
Mailing Address - Fax:208-762-7740
Practice Address - Street 1:1986 W HAYDEN AVE
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-7412
Practice Address - Country:US
Practice Address - Phone:208-762-7760
Practice Address - Fax:208-762-7740
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID630087363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner