Provider Demographics
NPI:1447258439
Name:YOUNG, STEFANIE L (CNM)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 MYRTLE ST STE G30
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-4610
Mailing Address - Country:US
Mailing Address - Phone:814-452-5514
Mailing Address - Fax:814-452-5504
Practice Address - Street 1:2315 MYRTLE ST STE G30
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-4610
Practice Address - Country:US
Practice Address - Phone:814-452-5514
Practice Address - Fax:814-452-5504
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181225367A00000X, 176B00000X
FLARNP-2987062367A00000X
PAMW010159367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023028540002Medicaid
PA1023028540004Medicaid
PA1023028540005Medicaid
PA1023028540003Medicaid
PA1023028540006Medicaid
PA1023028540006Medicaid