Healthcare Provider Details

I. General information

NPI: 1386171908
Provider Name (Legal Business Name): BRIANNE N. NICHOLAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRIANNE RUNYAN MD

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 BIELBY RD
LAWRENCEBURG IN
47025-1099
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 812-496-8771
  • Fax: 812-537-3936
Mailing address:
  • Phone: 859-496-8771
  • Fax: 812-537-3936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number56890
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01087484A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: