Provider Demographics
NPI:1073002275
Name:NORRIS-DECKARD, SANDRA (NP-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:NORRIS-DECKARD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11414 WALNUT MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-3987
Mailing Address - Country:US
Mailing Address - Phone:281-772-8814
Mailing Address - Fax:
Practice Address - Street 1:20550 TOWNSEN BLVD
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4445
Practice Address - Country:US
Practice Address - Phone:281-772-8814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137547363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX392140587Medicaid