Active NPI
Diane M Young, ARNP
- Nurse Practitioner
- Waterloo, IA
National Provider Identifier
1386914596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- J-054600
- Practice address
- 36 W Park LN
Waterloo, IA 50701-5178 - Phone
- (319) 234-0109
- Fax
- (319) 234-5774
- NPI assigned
- Jan 4, 2012
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | J-054600 | IA | Primary |
Addresses
Primary practice location
36 W Park LN
Waterloo, IA 50701-5178
Mailing address
36 W Park LN
Waterloo, IA 50701-5178
Phone (319) 234-0109
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J-054600 | IA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physical Medicine & Rehabilitation Associates of Northeast Iowa, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Medicine & Rehabilitation Physician
- Cedar Rapids, IA
- NPI 1528224664
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1325635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325635200000",
"number": "1386914596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36 W PARK LN",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507015178",
"telephone_number": "319-234-0109",
"fax_number": "319-234-5774"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36 W PARK LN",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507015178",
"telephone_number": "319-234-0109",
"fax_number": "319-234-5774"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "DIANE",
"middle_name": "M",
"credential": "ARNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-04",
"last_updated": "2012-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IA",
"license": "J-054600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterloo, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.