Provider Demographics
NPI:1407825003
Name:DECKER-MILLER, NANCY JEAN (CNM)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JEAN
Last Name:DECKER-MILLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:JEAN
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:5700 BOTTINEAU BLVD
Mailing Address - Street 2:#210
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429
Mailing Address - Country:US
Mailing Address - Phone:763-587-7000
Mailing Address - Fax:763-587-7015
Practice Address - Street 1:9825 HOSPITAL DR
Practice Address - Street 2:#205
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:763-587-7000
Practice Address - Fax:763-587-7015
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR127886-0176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN420000545Medicare ID - Type Unspecified
MNP35307Medicare UPIN