Provider Demographics
NPI:1891350005
Name:NICKERSON, CYNTHIA GORDON (RN CDE CMC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:GORDON
Last Name:NICKERSON
Suffix:
Gender:F
Credentials:RN CDE CMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AK
Mailing Address - Zip Code:99824-5115
Mailing Address - Country:US
Mailing Address - Phone:907-957-2999
Mailing Address - Fax:
Practice Address - Street 1:BARTLETT REGIONAL HOSPITAL
Practice Address - Street 2:3260 HOSPITAL DRIVE
Practice Address - City:DOUGLAS
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-796-8649
Practice Address - Fax:907-796-8574
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURR19700163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator