Individual
PHILLIP J NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12040 NE 128TH ST, KIRKLAND, WA 98034-3013
(425) 899-1000
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 520-5700
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD61060867
WA
208M00000X
Hospitalist Physician
Primary
MD61060867
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710334180
—
WA
Enumeration date
05/16/2016
Last updated
05/30/2025
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