Individual
DUSTIN DUANE NICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
2610 N 3RD ST, PHOENIX, AZ 85004-1102
(480) 610-6100
(480) 610-6189
Mailing address
2149 E WARNER RD STE 102, TEMPE, AZ 85284-3495
(480) 610-6100
(480) 610-6189
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
RN
AZ
363L00000X
Nurse Practitioner
Primary
AP11349
AZ
Other
Enumeration date
04/03/2018
Last updated
09/26/2018
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