MRS. SANDRA DENISE THEBAUD-YOUNG APRN-BC NPI 1114043064

NPI Information

NPI: 1114043064
Provider Name: MRS. SANDRA DENISE THEBAUD-YOUNG, APRN-BC
Classification: Nurse Practitioner - 363LA2200X
Entity Type: Individual

Specialization: Adult Health

PECOS Registration: Yes

Address:
254 EASTON AVENUE
NEW BRUNSWICK
NEW BRUNSWICK, NJ
ZIP 08901
Phone: (908) 392-1948
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MRS. Sandra Denise Thebaud-young, APRN-BC is an adult health nurse practitioner in New Brunswick, NJ with 18 years of experience. MRS. Sandra Denise Thebaud-young, APRN-BC NPI is 1114043064. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

254 EASTON AVENUE
NEW BRUNSWICK
NEW BRUNSWICK, NJ
ZIP 08901
Phone: (908) 392-1948
Fax: (973) 337-2045

The NPI 1114043064 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/22/2007 and was last updated on 10/26/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2200X	Nurse Practitioner	Adult Health	26NJ00129300	NEW JERSEY	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	112818VGD	OTHER		MEDICARE
2	0147320	MEDICAID	NEW JERSEY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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