Individual
MS. PATREIS DESTANIE YOUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1 S PARK ST, MADISON, WI 53715-1375
(608) 287-2450
Mailing address
1 S PARK ST, MADISON, WI 53715-1375
(608) 287-2450
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
8029
WI
Other
Enumeration date
05/17/2024
Last updated
11/12/2024
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