Provider Demographics
NPI:1811488976
Name:NICKEL, ALEXA VICTORIA (APRN)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:VICTORIA
Last Name:NICKEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:DR
Other - First Name:ALEXA
Other - Middle Name:VICTORIA
Other - Last Name:NICKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ALEXA SUGDEN
Mailing Address - Street 1:PO BOX 100253
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 E 3900 S UNIT G175
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1300
Practice Address - Country:US
Practice Address - Phone:801-268-7405
Practice Address - Fax:801-268-7435
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9127639-3102163W00000X
UT9127639-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse