Provider Demographics
NPI:1053154963
Name:DECKER, MELISSA A
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:DECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:ALGER
Mailing Address - State:OH
Mailing Address - Zip Code:45812-0294
Mailing Address - Country:US
Mailing Address - Phone:419-516-2939
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 294
Practice Address - Street 2:
Practice Address - City:ALGER
Practice Address - State:OH
Practice Address - Zip Code:45812-0294
Practice Address - Country:US
Practice Address - Phone:419-516-2939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0036608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily