Individual
MS. JEAN MARIE DECAVITCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
6831 W 133RD AVE, CEDAR LAKE, IN 46303-8989
(219) 374-5970
(219) 374-7505
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
28125157A
IN
363LF0000X
Family Nurse Practitioner
Primary
71004201A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201129930
—
IN
Enumeration date
10/13/2012
Last updated
05/03/2023
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