Healthcare Provider Details

I. General information

NPI: 1295236867
Provider Name (Legal Business Name): ROZETTE CASENE HENRYALVAREZ LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. ROZETTE CASENE BYNUM

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 JONES AVE S
RENTON WA
98055-4304
US

IV. Provider business mailing address

2602 WESTRIDGE AVE W APT Y201
TACOMA WA
98466-1892
US

V. Phone/Fax

Practice location:
  • Phone: 206-290-7006
  • Fax:
Mailing address:
  • Phone: 253-882-4401
  • Fax: 866-360-5916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP00057880
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: