Provider Demographics
NPI:1528604758
Name:DYCHES, NICHOLAS BROWN (NRP, FP-C, SO-ATP)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:BROWN
Last Name:DYCHES
Suffix:
Gender:M
Credentials:NRP, FP-C, SO-ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 AIRPORT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-3659
Mailing Address - Country:US
Mailing Address - Phone:702-228-5643
Mailing Address - Fax:
Practice Address - Street 1:4700 LAS VEGAS BLVD N BLDG 1300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89191-6600
Practice Address - Country:US
Practice Address - Phone:702-228-5643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians