Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 7827540-4405 | UT |
NPI | 1003245689 |
---|---|
Provider Name | Jocelyn Decker |
First Address | Magna, UT 84044-4907 |
Second Address | Magna, UT 84044-4907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2013 |
Last Update Date | 19/10/2021 |