Provider Demographics
NPI:1720627615
Name:YUHMO, WANESA DIANE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:WANESA
Middle Name:DIANE
Last Name:YUHMO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4680 POLARIS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-5600
Mailing Address - Country:US
Mailing Address - Phone:702-909-5900
Mailing Address - Fax:702-333-4777
Practice Address - Street 1:4680 POLARIS AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5600
Practice Address - Country:US
Practice Address - Phone:702-909-5900
Practice Address - Fax:702-333-4777
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-25
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV826505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily