Provider Demographics
NPI:1932667862
Name:WYCHE, GREGORY ARIC (RN)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ARIC
Last Name:WYCHE
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 1:523 W 160TH ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-6626
Mailing Address - Country:US
Mailing Address - Phone:917-446-6964
Mailing Address - Fax:
Practice Address - Street 1:523 W 160TH ST APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-6626
Practice Address - Country:US
Practice Address - Phone:917-446-6964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY716259163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY716259OtherLICENSE NUMBER