Healthcare Provider Details

I. General information

NPI: 1285610493
Provider Name (Legal Business Name): NANCY M NICKERSON GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 GRAHAM ST
BIDDEFORD ME
04005-3853
US

IV. Provider business mailing address

PO BOX 284
BRATTLEBORO VT
05302-0284
US

V. Phone/Fax

Practice location:
  • Phone: 207-602-3571
  • Fax: 207-602-3573
Mailing address:
  • Phone: 207-784-2554
  • Fax: 207-777-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN25597
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberCNP81608
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: