Provider Demographics
NPI:1942564158
Name:BRASSEUR, NATHAN C (AT, ATC, EMT-P)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:C
Last Name:BRASSEUR
Suffix:
Gender:M
Credentials:AT, ATC, EMT-P
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:6420 E TROPICANA AVE SPC 89
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-7515
Mailing Address - Country:US
Mailing Address - Phone:989-370-2072
Mailing Address - Fax:
Practice Address - Street 1:6420 E TROPICANA AVE SPC 89
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-7515
Practice Address - Country:US
Practice Address - Phone:989-370-2072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010008622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer