Individual
ALICE C GUNNISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
2406 WEST BROADWAY, JENCARE NEIGHBORHOOD MEDICAL CENTER WEST BROADWAY, LLC, LOUISVILLE, KY 40211
(502) 775-1211
(502) 775-1221
Mailing address
2406 WEST BROADWAY, JENCARE NEIGHBORHOOD MEDICAL CENTER WEST BROADWAY, LLC, LOUISVILLE, KY 40211
(502) 775-1211
(502) 775-1221
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA159
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95001590
—
KY
Enumeration date
01/05/2006
Last updated
07/20/2015
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