Healthcare Provider Details

I. General information

NPI: 1740757525
Provider Name (Legal Business Name): GRACE MICHELLE DYKHENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date: 07/26/2024
Reactivation Date: 08/22/2024

III. Provider practice location address

2700 E. SUNSET RD., #17 BLDG B
LAS VEGAS NV
89120-3508
US

IV. Provider business mailing address

2700 E SUNSET RD STE 17
LAS VEGAS NV
89120-3508
US

V. Phone/Fax

Practice location:
  • Phone: 702-479-8809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number7854PCS3
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6407
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: