Healthcare Provider Details

I. General information

NPI: 1629793617
Provider Name (Legal Business Name): JOANN YEARWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5609 PELLA POMPANO ST
NORTH LAS VEGAS NV
89031-3697
US

IV. Provider business mailing address

5609 PELLA POMPANO ST
NORTH LAS VEGAS NV
89031-3697
US

V. Phone/Fax

Practice location:
  • Phone: 702-778-7440
  • Fax: 702-463-7527
Mailing address:
  • Phone: 702-778-7440
  • Fax: 702-463-7527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: