Provider Demographics
NPI:1912199225
Name:DYCHE, GREGORY RAND (RN)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:RAND
Last Name:DYCHE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7307 PERERA CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4527
Mailing Address - Country:US
Mailing Address - Phone:916-832-4734
Mailing Address - Fax:
Practice Address - Street 1:7307 PERERA CIR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-4527
Practice Address - Country:US
Practice Address - Phone:916-832-4734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA377451163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN001550OtherMEDI-CAL