Provider Demographics
NPI:1184421752
Name:YOUNG, DWAYNE RUSTY
Entity type:Individual
Prefix:
First Name:DWAYNE
Middle Name:RUSTY
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E 2ND ST # 281
Mailing Address - Street 2:
Mailing Address - City:ORCHARD
Mailing Address - State:NE
Mailing Address - Zip Code:68764-6304
Mailing Address - Country:US
Mailing Address - Phone:402-394-1538
Mailing Address - Fax:402-394-1538
Practice Address - Street 1:320 E 2ND ST # 281
Practice Address - Street 2:
Practice Address - City:ORCHARD
Practice Address - State:NE
Practice Address - Zip Code:68764-6304
Practice Address - Country:US
Practice Address - Phone:402-394-1538
Practice Address - Fax:402-394-1538
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant