Healthcare Provider Details

I. General information

NPI: 1437570702
Provider Name (Legal Business Name): MERYLYN YEGON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SHADOW LN
LAS VEGAS NV
89106-4363
US

IV. Provider business mailing address

400 SHADOW LN SUITE 208
LAS VEGAS NV
89106-4363
US

V. Phone/Fax

Practice location:
  • Phone: 702-759-1646
  • Fax: 702-868-2821
Mailing address:
  • Phone: 702-759-1646
  • Fax: 702-868-2821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN68870
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: