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Individual

JODI M DECKARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
333 WASHINGTON AVE N STE 5000, MINNEAPOLIS, MN 55401-1331
(612) 659-7111
(612) 659-7101
Mailing address
2003 BLAIR CT, BEL AIR, MD 21015-1678
(410) 776-3339

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R174883
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000374582
BCBS - MARY STREET
IN
01
000000381104
BCBS - GATEWAY
IN
05
200802970
IN
05
78015609
KY
Enumeration date
09/13/2006
Last updated
01/20/2009
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