Healthcare Provider Details

I. General information

NPI: 1699529412
Provider Name (Legal Business Name): AUSTIN BRETT DEAN APRN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4270 S DECATUR BLVD
LAS VEGAS NV
89103-6800
US

IV. Provider business mailing address

10380 BLUE GINGER DR
LAS VEGAS NV
89135-4058
US

V. Phone/Fax

Practice location:
  • Phone: 702-485-2100
  • Fax:
Mailing address:
  • Phone: 702-772-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number831983
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number831983
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: