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General NPI Number Information
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NPI Number | 1477062743
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Entity Type | Individual
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Provider Name | CHRISTOPHER MICHAEL NICKELSON
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Gender | Male
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Dates
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Enumeration Date | 09/29/2017
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Last Update Date | 01/29/2018
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Provider Practice Location Address
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Address Line | 2000 NEUSE BLVD
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City | NEW BERN
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State | NC
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Zip | 28560-3449
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Country | US
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Telephone | 252-633-8846
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Fax |
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Provider Business Mailing Address
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Address Line | 101 PORTER AVE
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City | SCOTTDALE
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State | PA
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Zip | 15683-1138
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Country | US
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Telephone |
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN639963
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 300495
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 120598
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License Number State | PA
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