Provider Demographics
NPI:1407988967
Name:DECKERT, CYNTHIA VERMILLION (NURSE)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:VERMILLION
Last Name:DECKERT
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:ANNITA
Other - Last Name:VERMILLION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:82936 OAK DR
Mailing Address - City:DEXTER
Mailing Address - State:OR
Mailing Address - Zip Code:97431-0367
Mailing Address - Country:US
Mailing Address - Phone:503-539-4363
Mailing Address - Fax:
Practice Address - Street 1:3225 STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5063
Practice Address - Country:US
Practice Address - Phone:503-584-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse