Provider Demographics
NPI:1356677140
Name:NICKERSON, CECILIA PIAI
Entity Type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:PIAI
Last Name:NICKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BRANDY LN
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03076-3566
Mailing Address - Country:US
Mailing Address - Phone:978-805-9727
Mailing Address - Fax:978-805-9720
Practice Address - Street 1:12 BRANDY LN
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NH
Practice Address - Zip Code:03076-3566
Practice Address - Country:US
Practice Address - Phone:978-805-9727
Practice Address - Fax:978-805-9720
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist