Provider Demographics
NPI:1629739776
Name:WALTON, YASUKO (CNA)
Entity Type:Individual
Prefix:
First Name:YASUKO
Middle Name:
Last Name:WALTON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 NOAH VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5067
Mailing Address - Country:US
Mailing Address - Phone:725-666-9272
Mailing Address - Fax:
Practice Address - Street 1:320 GOLDSTAR ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-0102
Practice Address - Country:US
Practice Address - Phone:702-401-9993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-31
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCNA023018253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care