1992939144 NPI number — MRS. DANAE DECKMAN

Table of content: MRS. DANAE DECKMAN (NPI 1992939144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992939144 NPI number — MRS. DANAE DECKMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DECKMAN
Provider First Name:
DANAE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1992939144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
406 S MULBERRY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMLAND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47340-9509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-620-8400
Provider Business Mailing Address Fax Number:
765-779-4010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6145 N COUNTY ROAD 940 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47356-9530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-620-8400
Provider Business Practice Location Address Fax Number:
765-779-4010
Provider Enumeration Date:
05/02/2009

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: 235Z00000X , with the licence number:  46001936A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 46001936A . This is a "IN STATE LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".