Provider Demographics
NPI:1477261527
Name:DECENA, EVARISTO JAMERO II (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:EVARISTO
Middle Name:JAMERO
Last Name:DECENA
Suffix:II
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:DING
Other - Middle Name:
Other - Last Name:DECENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 4001
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77342-4001
Mailing Address - Country:US
Mailing Address - Phone:936-304-1700
Mailing Address - Fax:936-304-1701
Practice Address - Street 1:110 MEMORIAL HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4940
Practice Address - Country:US
Practice Address - Phone:936-304-1700
Practice Address - Fax:936-304-1701
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1098556363LF0000X, 163WH0500X, 207Q00000X, 363LF0000X
TX734659163WG0000X, 163WH0500X
261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment