Individual
MRS. ANTONIA MARIE DECKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
4325 LAKE BOONE TRL STE 315, RALEIGH, NC 27607-7510
(984) 974-0496
Mailing address
4325 LAKE BOONE TRL STE 315, RALEIGH, NC 27607-7510
(849) 974-0496
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3951
WI
363AM0700X
Medical Physician Assistant
085.005534
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225409485
—
WI
Enumeration date
10/14/2015
Last updated
04/02/2021
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