1144209487 NPI number — MRS. RITA AMY DEKKER ARNP

Table of content: MRS. RITA AMY DEKKER ARNP (NPI 1144209487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144209487 NPI number — MRS. RITA AMY DEKKER ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEKKER
Provider First Name:
RITA
Provider Middle Name:
AMY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144209487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1769 BELL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33406-6580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-963-8446
Provider Business Mailing Address Fax Number:
561-297-3447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5205 GREENWOOD AVE
Provider Second Line Business Practice Location Address:
DIABETES EDUCATION CENTER
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-803-8880
Provider Business Practice Location Address Fax Number:
561-803-8899
Provider Enumeration Date:
01/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1011272 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 303420800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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