MEDICARE: AUSTIN BRETT DEAN APRN-CNP

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	163W00000X	Registered Nurse	831983	NV
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	831983	NV

General Provider Information

NPI Number	:	1699529412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN BRETT DEAN APRN-CNP

Provider Business Mailing Address
First Line	:	10380 BLUE GINGER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-4058
Country	:	US
Telephone Number	:	702-772-3555
Fax Number	:

Provider Business Practice Location Address
First Line	:	4270 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-6800
Country	:	US
Telephone Number	:	702-485-2100
Fax Number	:

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

Provider Enumeration Date	:	04/17/2024
Last Update Date	:	04/17/2024

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