Individual
HEATHER NICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS PA-C
Contact information
Practice address
365 MONTAUK AVE, NEW LONDON, CT 06320-4700
(508) 560-0011
Mailing address
39 CORRINE DR, EAST FALMOUTH, MA 02536-2708
(508) 560-0011
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
3135
CT
Other
Enumeration date
07/14/2014
Last updated
07/14/2014
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