Individual
EDWARD C NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
2801 K ST, STE 310, SACRAMENTO, CA 95816-5120
(916) 353-2270
(916) 353-2279
Mailing address
11251 COLOMA RD, STE J, GOLD RIVER, CA 95670-4431
(916) 353-2270
(916) 353-2279
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT12609
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12300100
USDL
CA
01
—
PT12609
BLUE CROSS
CA
01
—
PT90581
BLUE SHIELD
CA
Enumeration date
03/20/2007
Last updated
07/09/2007
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