Provider Demographics
NPI:1346359437
Name:DECKER, LISA A (APN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:DECKER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N WABASH
Mailing Address - Street 2:SUITE G20
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2600
Mailing Address - Country:US
Mailing Address - Phone:765-660-7440
Mailing Address - Fax:765-662-9907
Practice Address - Street 1:1136 N BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-4715
Practice Address - Country:US
Practice Address - Phone:765-660-7440
Practice Address - Fax:765-662-4715
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002213B363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000780698OtherANTHEM
IN200832930Medicaid
IN200832930Medicaid