MEDICARE: GRACE MARIANNE DYKHENG

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
1	163W00000X	Registered Nurse	70328	NV

General Provider Information

NPI Number	:	1558235580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE MARIANNE DYKHENG

Provider Business Mailing Address
First Line	:	8124 WILLMANN ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-2463
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8124 WILLMANN ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-2463
Country	:	US
Telephone Number	:	725-279-3127
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2025
Last Update Date	:	10/02/2025

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Directions to “ GRACE MARIANNE DYKHENG ” Practice Location

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