Individual
JENNIFER NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-3326
(215) 707-8028
Mailing address
11490 SPRINGFIELD PIKE, CINCINNATI, OH 45246-3524
(513) 672-3309
(513) 672-3323
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
272040
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200461980
—
IN
05
—
2340005
—
OH
Enumeration date
07/21/2005
Last updated
02/18/2025
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