Provider Demographics
NPI:1730754524
Name:NICKERSON, ARIEL NICOLE (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:NICOLE
Last Name:NICKERSON
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:MS
Other - First Name:ARIEL
Other - Middle Name:NICOLE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9309 BELAIR RD STE D
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1605
Mailing Address - Country:US
Mailing Address - Phone:443-668-2272
Mailing Address - Fax:
Practice Address - Street 1:9309 BELAIR RD STE D
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-1605
Practice Address - Country:US
Practice Address - Phone:410-505-7952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR209249363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health