NPI | 1992705131 |
---|---|
Former Name | DEANINE DECKER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 10933) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 10933) |
363AM0700X Physician Assistant, Medical | |
Enumeration Date | 2005-07-29 |
Last Update Date | 2025-07-16 |