Individual
MRS. DEBRA ANNE NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP-BC
Contact information
Practice address
1001 BLYTHE BLVD, SUITE 200, CHARLOTTE, NC 28203-5866
(704) 381-8840
(704) 381-8848
Mailing address
PO BOX 601372, 1001 BLYTHE BLVD., SUITE 200, CHARLOTTE, NC 28260-1372
(704) 381-8840
(704) 381-8848
Taxonomy
Speciality
Code
Description
License number
State
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
185859
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326274713
—
NC
05
—
NP3938
—
SC
Enumeration date
05/31/2009
Last updated
11/28/2016
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