Basic Information
Provider Information
NPI: 1336623099
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YOUNG
FirstName: ASHLEY
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential: AGACNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7570 CHRISLAND CV
Address2:  
City: FALLS CHURCH
State: VA
PostalCode: 220427598
CountryCode: US
TelephoneNumber: 5402704562
FaxNumber:  
Practice Location
Address1: 900 23RD ST NW
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200372342
CountryCode: US
TelephoneNumber: 2027154000
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/19/2018
LastUpdateDate: 09/19/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100XRN1045772DCY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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