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NPI Code Detail

MEDICARE: MRS. SUSAN WINTERHALTER DECKER PA-C

MEDICARE: MRS. SUSAN WINTERHALTER DECKER PA-C
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
1363AM0700XMedical Physician Assistant003154OH

General Provider Information

NPI Number : 1912288960
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN WINTERHALTER DECKER PA-C
Provider Business Mailing Address
First Line : 3806 NAUTILUS TRL
Second Line :
City : REMINDERVILLE
State : OH
Zip : 44202-9022
Country : US
Telephone Number : 610-248-5565
Fax Number :
Provider Business Practice Location Address
First Line : 6801 BRECKSVILLE RD STE 10
Second Line :
City : INDEPENDENCE
State : OH
Zip : 44131-5057
Country : US
Telephone Number : 216-636-8601
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2011
Last Update Date : 09/05/2011

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