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General NPI Number Information
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NPI Number | 1568153492
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Entity Type | Individual
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Provider Name | CARI NICKSON A-GNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/19/2023
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Last Update Date | 05/19/2023
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Provider Practice Location Address
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Address Line | 2142 ALPINE GLEN PL
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City | ALPINE
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State | CA
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Zip | 91901-2120
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Country | US
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Telephone | 619-228-5817
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Fax |
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Provider Business Mailing Address
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Address Line | 2142 ALPINE GLEN PL
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City | ALPINE
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State | CA
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Zip | 91901-2120
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Country | US
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Telephone | 619-228-5817
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | NP95025129
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License Number State | CA
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