Individual
MALISICA T BRUNNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN APRN FNP-C
Contact information
Practice address
1903 W HEBRON LN, SHEPHERDSVILLE, KY 40165-7425
(502) 367-3360
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 367-3360
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3016567
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100795200
—
KY
Enumeration date
09/14/2021
Last updated
07/23/2024
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