Active NPI
Wesley S Youngberg, DR.P.H.
- Nutritionist
- Tamuning, GU
National Provider Identifier
1124146550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- NUT000001
- Practice address
- 388 Ypao Rd
Tamuning, GU 96913-3701 - Phone
- (671) 647-4520
- Fax
- (671) 648-2557
- NPI assigned
- Mar 26, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | NUT000001 | GU | Primary |
Addresses
Primary practice location
388 Ypao Rd
Tamuning, GU 96913-3701
Mailing address
388 Ypao Rd
Tamuning, GU 96913-3701
Phone (671) 647-4520
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NUT000001 | Other | GU | GU BOARD OF ALLIED HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NUT000001 | GU | MD | Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201046400000",
"number": "1124146550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "388 YPAO RD",
"city": "TAMUNING",
"state": "GU",
"postal_code": "969133701",
"telephone_number": "671-647-4520",
"fax_number": "671-648-2557"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "388 YPAO RD",
"city": "TAMUNING",
"state": "GU",
"postal_code": "969133701",
"telephone_number": "671-647-4520",
"fax_number": "671-648-2557"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNGBERG",
"first_name": "WESLEY",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "DR.P.H.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-26",
"last_updated": "2008-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "GU",
"license": "NUT000001",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GU BOARD OF ALLIED HEALTH",
"identifier": "NUT000001",
"state": "GU"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tamuning, GU
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.