Individual
MRS. LISA A DECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1136 N BALDWIN AVE, MARION, IN 46952-4715
(765) 660-7440
(765) 662-4715
Mailing address
330 N WABASH, SUITE G20, MARION, IN 46952-2600
(765) 660-7440
(765) 662-9907
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
71002213B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000780698
ANTHEM
IN
05
—
200832930
—
IN
Enumeration date
08/30/2006
Last updated
10/19/2020
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