Healthcare Provider Details

I. General information

NPI: 1093784605
Provider Name (Legal Business Name): DEAN JOHN DYKE RN, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 W WASHINGTON ST
POYNETTE WI
53955-9449
US

IV. Provider business mailing address

238 W WASHINGTON ST
POYNETTE WI
53955-9449
US

V. Phone/Fax

Practice location:
  • Phone: 608-635-8622
  • Fax:
Mailing address:
  • Phone: 608-635-8622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number94377-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: