Provider Demographics
NPI:1992183693
Name:NICKEL, CIERRA
Entity Type:Individual
Prefix:
First Name:CIERRA
Middle Name:
Last Name:NICKEL
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 1:45768 COUNTY ROAD 10
Mailing Address - Street 2:
Mailing Address - City:SANBORN
Mailing Address - State:MN
Mailing Address - Zip Code:56083-4211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45768 COUNTY ROAD 10
Practice Address - Street 2:
Practice Address - City:SANBORN
Practice Address - State:MN
Practice Address - Zip Code:56083-4211
Practice Address - Country:US
Practice Address - Phone:507-227-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer