Provider Demographics
NPI:1366982522
Name:YOUNG HEALTH & WELLNESS
Entity type:Organization
Organization Name:YOUNG HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:801-815-2967
Mailing Address - Street 1:6321 S BOXWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2213
Mailing Address - Country:US
Mailing Address - Phone:801-815-2967
Mailing Address - Fax:
Practice Address - Street 1:3018 E 3300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-2144
Practice Address - Country:US
Practice Address - Phone:801-815-2967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5303618-4405363LF0000X
UT53036184405261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1366982522OtherPRACTICE NPI
UT1194122788OtherPROVIDER NPI
UT1194122788OtherPROVIDER NPI