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General NPI Number Information
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NPI Number | 1285610493
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Entity Type | Individual
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Provider Name | NANCY M NICKERSON GNP
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Gender | Female
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Dates
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Enumeration Date | 12/20/2005
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 208 GRAHAM ST
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City | BIDDEFORD
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State | ME
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Zip | 04005-3853
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Country | US
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Telephone | 207-602-3571
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Fax | 207-602-3573
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Provider Business Mailing Address
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Address Line | PO BOX 284
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City | BRATTLEBORO
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State | VT
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Zip | 05302-0284
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Country | US
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Telephone | 207-784-2554
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Fax | 207-777-5363
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | RN25597
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | CNP81608
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License Number State | ME
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