Provider Demographics
NPI:1194192062
Name:DEKKER, JAMI L (PA)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:L
Last Name:DEKKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JAMI
Other - Middle Name:L
Other - Last Name:CYNECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1678 STONY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1783
Mailing Address - Country:US
Mailing Address - Phone:989-600-1487
Mailing Address - Fax:
Practice Address - Street 1:11800 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3472
Practice Address - Country:US
Practice Address - Phone:586-576-1615
Practice Address - Fax:586-576-1628
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9109793363A00000X
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant