Individual
MRS. HEATHER DECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7575 GRAND RIVER RD, BRIGHTON, MI 48114-9309
(810) 844-7290
(810) 844-7295
Mailing address
24 FRANK LLOYD WRIGHT DR LBBY J2000, ANN ARBOR, MI 48105-9484
(734) 747-6766
(734) 222-3100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004411
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-5-25-1236-0
BLUE CROSS OF MICHIGAN
MI
Enumeration date
01/26/2006
Last updated
04/30/2020
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