Individual
RYAN PATRICK NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1719 E 19TH AVE, DENVER, CO 80218-1235
(303) 263-1972
Mailing address
3139 N GAYLORD ST, DENVER, CO 80205-4128
(720) 754-4800
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0995952
CO
363LA2100X
Acute Care Nurse Practitioner
PENDING
CO
Other
Enumeration date
09/15/2020
Last updated
11/29/2022
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