Provider Demographics
NPI:1013437110
Name:DYCE, EVAN LUCAS (CNP)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:LUCAS
Last Name:DYCE
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 CHARDONNAY LN NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-1901
Mailing Address - Country:US
Mailing Address - Phone:507-828-6318
Mailing Address - Fax:
Practice Address - Street 1:1107 HART BLVD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8538
Practice Address - Country:US
Practice Address - Phone:763-271-2200
Practice Address - Fax:763-271-1799
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily