Individual
LISA DECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
12 E 5TH ST, NEWPORT, KY 41071-1618
(859) 491-6510
Mailing address
502 FARRELL DR, COVINGTON, KY 41011-3717
(859) 578-3204
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
1135114
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
610661458
TAX ID
KY
Enumeration date
06/11/2013
Last updated
06/11/2013
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