| NPI | 1942589080 |
|---|---|
| Former Name | SUSAN MICHELLE DECKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MN 11268) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WV 01570) |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2014-11-03 |