Provider Demographics
NPI:1407345655
Name:BEYER-DICH, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:BEYER-DICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 N 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090-1704
Mailing Address - Country:US
Mailing Address - Phone:262-689-7893
Mailing Address - Fax:
Practice Address - Street 1:N107W14215 WHITE PINE CT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-6209
Practice Address - Country:US
Practice Address - Phone:414-870-3215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI232789163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse