Provider Demographics
NPI:1265740971
Name:EAST, YAWAN (LPN)
Entity type:Individual
Prefix:
First Name:YAWAN
Middle Name:
Last Name:EAST
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 ELM ST STE 270
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-2781
Mailing Address - Country:US
Mailing Address - Phone:937-955-9008
Mailing Address - Fax:
Practice Address - Street 1:2626 FALMOUTH AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1605
Practice Address - Country:US
Practice Address - Phone:937-985-7551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2023-01-06
Deactivation Date:2017-03-30
Deactivation Code:
Reactivation Date:2022-12-14
Provider Licenses
StateLicense IDTaxonomies
OH141254164W00000X
343900000X
OHRU412526347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)