Provider Demographics
NPI:1477805299
Name:ALEWINE, TYREE JR (LVN)
Entity type:Individual
Prefix:MR
First Name:TYREE
Middle Name:
Last Name:ALEWINE
Suffix:JR
Gender:M
Credentials:LVN
Other - Prefix:MR
Other - First Name:TYREE
Other - Middle Name:
Other - Last Name:ALEWINE
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:5216 E LIBERTY AVE
Mailing Address - Street 2:4556 W PALO ALTA AVE
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-5220
Mailing Address - Country:US
Mailing Address - Phone:559-513-9630
Mailing Address - Fax:559-255-6318
Practice Address - Street 1:5216 E LIBERTY AVE
Practice Address - Street 2:4556 W PALO ALTA AVE
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-5220
Practice Address - Country:US
Practice Address - Phone:559-513-9630
Practice Address - Fax:559-255-6318
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA264074164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse