Healthcare Provider Details

I. General information

NPI: 1649456047
Provider Name (Legal Business Name): NICOLE L BRODEUR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 JUNCTION DR
ALLEN TX
75013-5006
US

IV. Provider business mailing address

16182 PEBBLESTONE CV
FRISCO TX
75035-1630
US

V. Phone/Fax

Practice location:
  • Phone: 214-547-8300
  • Fax: 214-547-9787
Mailing address:
  • Phone: 214-505-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number699527
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: