Individual
NICOLE RENEE BRUNAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
#2 MEMORIAL DR., SUITE 103, ALTON, IL 62002-6723
(618) 463-7246
Mailing address
2 MEMORIAL DR STE 103, ALTON, IL 62002-6723
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
209022501
IL
363LP2300X
Primary Care Nurse Practitioner
209022501
IL
Other
Enumeration date
06/10/2021
Last updated
10/14/2025
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