Provider Demographics
NPI:1730736406
Name:YOHANNES, YESHAREG
Entity type:Individual
Prefix:
First Name:YESHAREG
Middle Name:
Last Name:YOHANNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 SICILIANO ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-7515
Mailing Address - Country:US
Mailing Address - Phone:702-788-5892
Mailing Address - Fax:
Practice Address - Street 1:3601 EL CONLON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-5858
Practice Address - Country:US
Practice Address - Phone:702-510-7145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000619501OtherNPI