Provider Demographics
NPI:1265673925
Name:DECKER, HANNAH NICOLE (PA)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:NICOLE
Last Name:DECKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:NICOLE
Other - Last Name:COLGROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:24651 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5635
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:14601 DETROIT AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4214
Practice Address - Country:US
Practice Address - Phone:216-226-8700
Practice Address - Fax:216-221-3171
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-002804363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant