Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Jack Philip Nickerson, CRNA

Individual provider Certified Registered Nurse Anesthetist · NPI 1447262548

Mr. Jack Philip Nickerson, CRNA is a Certified Registered Nurse Anesthetist in Grand Rapids, Michigan. Licensed in Michigan. Registered with an NPI since 2006.

Licensed in
MI
In the registry since
2006
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

See every abbreviation used in this directory →

Practice location Address checks out

3333 Evergreen Dr NE
Grand Rapids, MI 49525-9756
Phone: (616) 364-4200
Fax: (616) 364-7347
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 4704234290 (MI)

Record details

NPI number1447262548
Entity typeIndividual (Type 1)
GenderMale
Credentials CRNA
Sole proprietorNo
NPI enumeratedAugust 13, 2006
Last updated in NPPESAugust 30, 2010

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