MEDICARE: MRS. CHRISTINE A DECK CNP

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	363LF0000X	Family Nurse Practitioner	210823	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851377337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE A DECK CNP

Provider Business Mailing Address
First Line	:	1303 CALIFORNIA AVE
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-8737
Country	:	US
Telephone Number	:	330-875-3353
Fax Number	:	330-875-2746

Provider Business Practice Location Address
First Line	:	1303 CALIFORNIA AVE
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641
Country	:	US
Telephone Number	:	330-875-3353
Fax Number	:	330-875-2746

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	05/21/2018

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