Provider Demographics
NPI:1851130686
Name:KLEWENO, TYLIE
Entity type:Individual
Prefix:
First Name:TYLIE
Middle Name:
Last Name:KLEWENO
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 1:290 HEIDELBERG DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-2111
Mailing Address - Country:US
Mailing Address - Phone:513-237-8880
Mailing Address - Fax:
Practice Address - Street 1:1949 MELLOW WOOD LN
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-2620
Practice Address - Country:US
Practice Address - Phone:513-295-0798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant