Provider Demographics
NPI:1386914596
Name:YOUNG, DIANE M (ARNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:M
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 1:36 W PARK LN
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5178
Mailing Address - Country:US
Mailing Address - Phone:319-234-0109
Mailing Address - Fax:319-234-5774
Practice Address - Street 1:36 W PARK LN
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5178
Practice Address - Country:US
Practice Address - Phone:319-234-0109
Practice Address - Fax:319-234-5774
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAJ-054600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner