Provider Demographics
NPI:1144327842
Name:EWING, LYNETTE DEE (PSYCHIATRIC TECH)
Entity type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:DEE
Last Name:EWING
Suffix:
Gender:F
Credentials:PSYCHIATRIC TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15573 RICHVALE DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-3253
Mailing Address - Country:US
Mailing Address - Phone:562-943-0692
Mailing Address - Fax:
Practice Address - Street 1:1030 W WARNER AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3147
Practice Address - Country:US
Practice Address - Phone:714-834-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30680167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician