Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | SP023154 | PA |
NPI | 1013507797 |
---|---|
Provider Name | Amanda Decker |
First Address | Mount Laurel, NJ 08054-0813 |
Second Address | Holicong, PA 18928-5000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2021 |
Last Update Date | 23/07/2021 |