MEDICARE: ANDREA DECKER MS, RD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	2006011037	MO

General Provider Information

NPI Number	:	1407138332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA DECKER MS, RD, LD

Provider Business Mailing Address
First Line	:	411 N EUCLID AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1601
Country	:	US
Telephone Number	:	618-972-8478
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 N EUCLID AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1601
Country	:	US
Telephone Number	:	618-972-8478
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	09/16/2011

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