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Organization

DECORUM HEALTH SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TRACY L ZIKES NP (AUTHORIZED OFFICIAL PRESIDENT)
(540) 392-3699
Entity
Organization

Contact information

Practice address
3615 W MAIN ST, SALEM, VA 24153-1961
(540) 378-9772
Mailing address
PO BOX 31494, HENRICO, VA 23294-1494
(540) 392-3699

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
363LA2200X
Adult Health Nurse Practitioner
363LG0600X
Gerontology Nurse Practitioner
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0024172938
MEDICAL LICENSE VIRGINIA
VA
Enumeration date
04/28/2020
Last updated
03/07/2023
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