Provider Demographics
NPI:1841898020
Name:YOUNGBIRD, LORNA DENISE
Entity type:Individual
Prefix:
First Name:LORNA
Middle Name:DENISE
Last Name:YOUNGBIRD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 12TH AVE SE LOT 86
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-3823
Mailing Address - Country:US
Mailing Address - Phone:701-381-2581
Mailing Address - Fax:701-766-1870
Practice Address - Street 1:502 12TH AVE SE LOT 86
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3823
Practice Address - Country:US
Practice Address - Phone:701-381-2581
Practice Address - Fax:701-766-1870
Is Sole Proprietor?:No
Enumeration Date:2020-10-11
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant