Provider Demographics
NPI:1467113399
Name:NICKERSON, LAUREN ASHLEY (NP-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ASHLEY
Last Name:NICKERSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 HOBART ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2379
Mailing Address - Country:US
Mailing Address - Phone:231-876-2644
Mailing Address - Fax:
Practice Address - Street 1:6152 BELLOWS LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE ANN
Practice Address - State:MI
Practice Address - Zip Code:49650-9713
Practice Address - Country:US
Practice Address - Phone:313-590-2631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704275084163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse