Healthcare Provider Details

I. General information

NPI: 1265740971
Provider Name (Legal Business Name): YAWAN EAST LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date: 03/30/2017
Reactivation Date: 12/14/2022

III. Provider practice location address

2626 FALMOUTH AVE
DAYTON OH
45406-1605
US

IV. Provider business mailing address

311 ELM ST STE 270
CINCINNATI OH
45202-2781
US

V. Phone/Fax

Practice location:
  • Phone: 937-985-7551
  • Fax:
Mailing address:
  • Phone: 937-955-9008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberRU412526
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number141254
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: