Heather Nickerson, MS PA-C
Physician Assistant, Surgical in New London, CT. Individual provider (NPI-1).
NPI number1669889481
StatusActive
Last updated in NPPESJul 14, 2014
Details
- NPI
- 1669889481
- Entity type
- Individual (NPI-1)
- Name
- Heather Nickerson
- Credential
- MS PA-C
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jul 14, 2014
- Last updated
- Jul 14, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AS0400X | Physician Assistant, Surgical | 3135 | CT | Yes |
Practice location
365 Montauk AveNew London, CT 06320-4700
Phone 508-560-0011
Mailing address
39 Corrine DrEast Falmouth, MA 02536-2708
Phone 508-560-0011
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