Provider Demographics
NPI:1033168265
Name:DECKER, DEBORAH LYNN (APNP,FNP-C,MSN,APRN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:DECKER
Suffix:
Gender:F
Credentials:APNP,FNP-C,MSN,APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 RIVERSIDE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2300
Mailing Address - Country:US
Mailing Address - Phone:920-406-0908
Mailing Address - Fax:920-433-9927
Practice Address - Street 1:2020 RIVERSIDE DR STE 200
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2300
Practice Address - Country:US
Practice Address - Phone:920-433-9920
Practice Address - Fax:920-433-9927
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2358-33363L00000X
WI2358-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1033168265Medicaid
WI1033168265Medicaid