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General NPI Number Information
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NPI Number | 1538485180
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Entity Type | Individual
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Provider Name | NICOLAS A BREGANTE PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 725 FAIR ST
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City | BUHL
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State | ID
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Zip | 83316-6442
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Country | US
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Telephone | 208-543-8271
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Fax | 208-543-8272
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Provider Business Mailing Address
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Address Line | 794 EASTLAND DR
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City | TWIN FALLS
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State | ID
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Zip | 83301-6856
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Country | US
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Telephone | 208-734-3312
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Fax | 208-734-5036
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-1008
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60141280
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License Number State | WA
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