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General NPI Number Information
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NPI Number | 1760797229
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Entity Type | Individual
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Provider Name | RENEE NICKERSON NP
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Gender | Female
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Dates
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Enumeration Date | 08/09/2010
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 5108 VELASKO RD STE 2000
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City | SYRACUSE
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State | NY
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Zip | 13215-1982
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Country | US
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Telephone | 315-924-6555
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Fax | 315-306-7737
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Provider Business Mailing Address
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Address Line | 3942 ROCKWELL RD
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City | MARCELLUS
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State | NY
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Zip | 13108-9640
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Country | US
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Telephone | 315-673-2802
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 402840
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 335994
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License Number State | NY
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