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NPI Code Detail

MEDICARE: CHERYL S. DECKER MS, RD, CD

MEDICARE: CHERYL S. DECKER MS, RD, CD
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
1133V00000XRegistered Dietitian1001838WA

General Provider Information

NPI Number : 1629375043
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERYL S. DECKER MS, RD, CD
Provider Business Mailing Address
First Line : 18062 25TH AVE NE
Second Line :
City : LAKE FOREST PARK
State : WA
Zip : 98155-3906
Country : US
Telephone Number : 425-736-5273
Fax Number : 206-364-2156
Provider Business Practice Location Address
First Line : 18062 25TH AVE NE
Second Line :
City : LAKE FOREST PARK
State : WA
Zip : 98155-3906
Country : US
Telephone Number : 425-736-5273
Fax Number : 206-364-2156
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2011
Last Update Date : 02/21/2011

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