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General NPI Number Information
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NPI Number | 1891794772
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Entity Type | Individual
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Provider Name | JENNIFER NICKERSON CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 3401 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5103
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Country | US
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Telephone | 215-707-3326
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Fax | 215-707-8028
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Provider Business Mailing Address
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Address Line | 11490 SPRINGFIELD PIKE
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City | CINCINNATI
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State | OH
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Zip | 45246-3524
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Country | US
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Telephone | 513-672-3309
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Fax | 513-672-3323
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 272040
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License Number State | OH
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