MEDICARE: NICHOLAS ROBERT BRULE

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	207X00000X	Orthopaedic Surgery Physician	29525	NV
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1073148201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS ROBERT BRULE

Provider Business Mailing Address
First Line	:	1800 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2329
Country	:	US
Telephone Number	:	702-383-2799
Fax Number	:	702-383-2477

Provider Business Practice Location Address
First Line	:	2231 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2254
Country	:	US
Telephone Number	:	702-383-2663
Fax Number	:	702-383-2682

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

Provider Enumeration Date	:	03/09/2020
Last Update Date	:	06/04/2026

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