MEDICARE: JODI M DECKARD NP

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	363L00000X	Nurse Practitioner	R174883	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000374582	OTHER	IN	BCBS - MARY STREET
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000381104	OTHER	IN	BCBS - GATEWAY

General Provider Information

NPI Number	:	1871698373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI M DECKARD NP

Provider Business Mailing Address
First Line	:	2003 BLAIR CT
Second Line	:
City	:	BEL AIR
State	:	MD
Zip	:	21015-1678
Country	:	US
Telephone Number	:	410-776-3339
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 WASHINGTON AVE N STE 5000
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-1331
Country	:	US
Telephone Number	:	612-659-7111
Fax Number	:	612-659-7101

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	01/20/2009

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