Provider Demographics
NPI:1386995587
Name:YENGWIA, CLOVIS
Entity type:Individual
Prefix:
First Name:CLOVIS
Middle Name:
Last Name:YENGWIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6578 HILLSIDE PINE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4229
Mailing Address - Country:US
Mailing Address - Phone:702-972-7789
Mailing Address - Fax:
Practice Address - Street 1:3365 WYNN RD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8202
Practice Address - Country:US
Practice Address - Phone:702-331-4161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide