Provider Demographics
NPI:1871331207
Name:NIBERT-YOUNG, LAURA MARLENE (RN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARLENE
Last Name:NIBERT-YOUNG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7589 SW THORNTON DR
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-6554
Mailing Address - Country:US
Mailing Address - Phone:503-601-9949
Mailing Address - Fax:
Practice Address - Street 1:7589 SW THORNTON DR
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-6554
Practice Address - Country:US
Practice Address - Phone:503-601-9949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201043261163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse