Individual
MRS. LEANN B YOUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
8600 N ROUTE 91, SUITE 130, PEORIA, IL 61615
(309) 683-5059
(309) 683-5446
Mailing address
8600 N ROUTE 91, SUITE 130, PEORIA, IL 61615
(309) 683-5059
(309) 683-5446
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085001383
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
434110
MEDICARE GROUP
IL
01
—
920006568
RAILROAD MEDICARE
IL
01
—
CA4079
RR MEDICARE GROUP PTAN
IL
01
—
P00608470
RR MEDICARE GROUP MEMBER PTAN
IL
Enumeration date
08/05/2006
Last updated
08/19/2008
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