Organization
EAST LAKE MEDICAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENA DECANTER NP (NURSE PRACTITIONER)
(903) 650-8619
Entity
Organization
Contact information
Practice address
11980 STATE HIGHWAY 64 E STE G, TYLER, TX 75707-2541
(903) 650-8619
(903) 650-8576
Mailing address
11980 STATE HIGHWAY 64 E STE G, TYLER, TX 75707-2541
(903) 650-8619
(903) 650-8576
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/03/2022
Last updated
06/03/2022
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