Provider Demographics
NPI:1184324600
Name:YOUNG, MELANIE ANN
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:YOUNG
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 1:4345 HARRISON BLVD # 101
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3103
Mailing Address - Country:US
Mailing Address - Phone:385-350-8500
Mailing Address - Fax:385-350-8555
Practice Address - Street 1:4345 HARRISON BLVD # 101
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3103
Practice Address - Country:US
Practice Address - Phone:385-350-8500
Practice Address - Fax:385-350-8555
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7238081-8900363LF0000X
UT7238081163WN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience