Provider Demographics
NPI:1679696512
Name:DECKER, SUSIE RACHELLE
Entity type:Individual
Prefix:MRS
First Name:SUSIE
Middle Name:RACHELLE
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 63
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:66839-0063
Mailing Address - Country:US
Mailing Address - Phone:620-364-5622
Mailing Address - Fax:620-364-2376
Practice Address - Street 1:200 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KS
Practice Address - Zip Code:66839-1354
Practice Address - Country:US
Practice Address - Phone:620-364-5622
Practice Address - Fax:620-364-2376
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management