Individual
MS. CHEVONNE MARIE NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
130 CENTERWAY, CORNING, NY 14830
(607) 973-8000
(607) 973-8161
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
F331493
NY
363LF0000X
Family Nurse Practitioner
Primary
F331493-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01731906
—
NY
01
—
500019277
RR MEDICARE PIN
NY
01
—
CC8362
RR MEDICARE GROUP
NY
Enumeration date
02/07/2006
Last updated
03/24/2021
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