Healthcare Provider Details

I. General information

NPI: 1750790416
Provider Name (Legal Business Name): DEANNA MICHELLE NICKERSON AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 ARCH ST STE 2A
AKRON OH
44304-1424
US

IV. Provider business mailing address

55 ARCH ST STE 2A
AKRON OH
44304-1424
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-6917
  • Fax: 330-535-1539
Mailing address:
  • Phone: 330-375-6917
  • Fax: 330-535-1539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number12194
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.02339
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: