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NPI Code Detail

MEDICARE: MR. NICHOLAS BROWN DYCHES NRP, FP-C, SO-ATP

MEDICARE: MR. NICHOLAS BROWN DYCHES NRP, FP-C, SO-ATP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11710I1003XIndependent Duty Medical Technicians

General Provider Information

NPI Number : 1528604758
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NICHOLAS BROWN DYCHES NRP, FP-C, SO-ATP
Provider Business Mailing Address
First Line : 1421 AIRPORT RD STE 100
Second Line :
City : BOULDER CITY
State : NV
Zip : 89005-3659
Country : US
Telephone Number : 702-228-5643
Fax Number :
Provider Business Practice Location Address
First Line : 4700 LAS VEGAS BLVD N BLDG 1300
Second Line :
City : LAS VEGAS
State : NV
Zip : 89191-6600
Country : US
Telephone Number : 702-228-5643
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2019
Last Update Date : 11/22/2019

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