Healthcare Provider Details

I. General information

NPI: 1912775347
Provider Name (Legal Business Name): APRIL NICKERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E MAIN ST
SANTA PAULA CA
93060-2748
US

IV. Provider business mailing address

2439 LEE ST
SIMI VALLEY CA
93065-3629
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-6830
  • Fax:
Mailing address:
  • Phone: 805-750-1007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN95239314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: