Provider Demographics
NPI:1477187813
Name:DEKKER, KATELIN ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:KATELIN
Middle Name:ELIZABETH
Last Name:DEKKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 HERITAGE S
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MI
Mailing Address - Zip Code:49419-9600
Mailing Address - Country:US
Mailing Address - Phone:231-233-1739
Mailing Address - Fax:
Practice Address - Street 1:200 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:FENNVILLE
Practice Address - State:MI
Practice Address - Zip Code:49408-8478
Practice Address - Country:US
Practice Address - Phone:269-561-8761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704293520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily