Provider Demographics
NPI:1174170609
Name:BROWN, WANAKEA
Entity type:Individual
Prefix:
First Name:WANAKEA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 CAPISTRANO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2228
Mailing Address - Country:US
Mailing Address - Phone:216-712-1142
Mailing Address - Fax:
Practice Address - Street 1:6615 S EASTERN AVE STE 104
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3926
Practice Address - Country:US
Practice Address - Phone:702-722-6200
Practice Address - Fax:702-722-6202
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV251E00000XOtherHOME HEALTH