Individual
ANNA MARIE NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1330 W RAMSEY ST, BANNING, CA 92220-4477
(951) 551-2473
Mailing address
1330 W RAMSEY ST, BANNING, CA 92220-4477
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
CA
175T00000X
Peer Specialist
Primary
MPSS-UTBZH
CA
Other
Enumeration date
07/12/2024
Last updated
10/22/2024
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