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General NPI Number Information
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NPI Number | 1790123842
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Entity Type | Individual
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Provider Name | LISA DECKER RN
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Gender | Female
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Dates
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Enumeration Date | 06/11/2013
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Last Update Date | 06/11/2013
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Provider Practice Location Address
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Address Line | 12 E 5TH ST
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City | NEWPORT
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State | KY
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Zip | 41071-1618
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Country | US
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Telephone | 859-491-6510
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Fax |
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Provider Business Mailing Address
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Address Line | 502 FARRELL DR
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City | COVINGTON
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State | KY
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Zip | 41011-3717
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Country | US
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Telephone | 859-578-3204
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 1135114
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License Number State | KY
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