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General NPI Number Information
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NPI Number | 1194192062
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Entity Type | Individual
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Provider Name | JAMI L DEKKER PA
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Gender | Female
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Dates
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Enumeration Date | 08/27/2015
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 11800 E 12 MILE RD
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City | WARREN
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State | MI
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Zip | 48093-3472
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Country | US
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Telephone | 586-576-1615
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Fax | 586-576-1628
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Provider Business Mailing Address
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Address Line | 1678 STONY CREEK DR
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City | ROCHESTER
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State | MI
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Zip | 48307-1783
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Country | US
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Telephone | 989-600-1487
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9109793
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | MI
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