Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | R052812 | MD |
NPI | 1003907106 |
---|---|
Provider Name | Mrs. Carolyn R. Decker |
First Address | Pasadena, MD 21122-5622 |
Second Address | Pasadena, MD 21122-5622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/07/2007 |