MEDICARE: MR. YVON J JEANNOT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171WV0202X	Vehicle Modifications Contractor		NV

General Provider Information

NPI Number	:	1194531632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. YVON J JEANNOT

Provider Business Mailing Address
First Line	:	5905 LAVENDER BREEZE ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6848
Country	:	US
Telephone Number	:	702-806-4641
Fax Number	:

Provider Business Practice Location Address
First Line	:	5905 LAVENDER BREEZE ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6848
Country	:	US
Telephone Number	:	702-806-4641
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2024
Last Update Date	:	12/09/2024

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