Provider Demographics
NPI:1437570702
Name:YEGON, MERYLYN (RN)
Entity Type:Individual
Prefix:
First Name:MERYLYN
Middle Name:
Last Name:YEGON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SHADOW LN
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4363
Mailing Address - Country:US
Mailing Address - Phone:702-759-1646
Mailing Address - Fax:702-868-2821
Practice Address - Street 1:400 SHADOW LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4363
Practice Address - Country:US
Practice Address - Phone:702-759-1646
Practice Address - Fax:702-868-2821
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN68870163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV163WC1500XMedicaid
NVRN68870Medicaid