Healthcare Provider Details

I. General information

NPI: 1013318518
Provider Name (Legal Business Name): NICOLE WYCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9975 MEDICAL CENTER DR
ROCKVILLE MD
20850-3316
US

IV. Provider business mailing address

9975 MEDICAL CENTER DR
ROCKVILLE MD
20850-3316
US

V. Phone/Fax

Practice location:
  • Phone: 301-738-9691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number03801
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: