1407988967 NPI number — CYNTHIA VERMILLION DECKERT NURSE

Table of content: CYNTHIA VERMILLION DECKERT NURSE (NPI 1407988967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407988967 NPI number — CYNTHIA VERMILLION DECKERT NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DECKERT
Provider First Name:
CYNTHIA
Provider Middle Name:
VERMILLION
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VERMILLION
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
ANNITA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NURSE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407988967
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 367
Provider Second Line Business Mailing Address:
82936 OAK DR
Provider Business Mailing Address City Name:
DEXTER
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97431-0367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-539-4363
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3225 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97301-5063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-584-2301
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/11/2007

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: 163W00000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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