Organization
DECORUM HEALTH SERVICES
Active
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
Update your record
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