Provider Demographics
NPI:1386171908
Name:NICHOLAS, BRIANNE N (MD)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:N
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRIANNE
Other - Middle Name:
Other - Last Name:RUNYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-496-8771
Mailing Address - Fax:812-537-3936
Practice Address - Street 1:368 BIELBY RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1099
Practice Address - Country:US
Practice Address - Phone:812-496-8771
Practice Address - Fax:812-537-3936
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY56890208600000X
IN01087484A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery