Provider Demographics
NPI:1104663392
Name:NICKERSON, MARGARET CLARE
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:CLARE
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 1:4123 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2410
Mailing Address - Country:US
Mailing Address - Phone:317-460-7383
Mailing Address - Fax:
Practice Address - Street 1:4123 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2410
Practice Address - Country:US
Practice Address - Phone:317-460-7383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-13
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program