Individual
MICHAEL NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
333 BORTHWICK AVE, EMERGENCY DEPARTMENT, PORTSMOUTH, NH 03801-7128
(603) 433-4012
(603) 433-5184
Mailing address
333 BORTHWICK AVE, EMERGENCY DEPARTMENT, PORTSMOUTH, NH 03801-7128
(603) 433-4012
(603) 433-5184
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
033993-23-03
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0711608
—
MA
05
—
247490099
—
ME
05
—
30011603
—
NH
01
—
4007290Y0NH01
ANTHEM
NH
01
—
930112668
RAILROAD MEDICARE
—
Enumeration date
08/05/2006
Last updated
08/10/2012
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