Provider Demographics
NPI:1558811893
Name:DECOTEAU, AUBREY CLAIRE MOWERY (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:CLAIRE MOWERY
Last Name:DECOTEAU
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 SHEYENNE ST STE 240
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8546
Mailing Address - Country:US
Mailing Address - Phone:701-364-1530
Mailing Address - Fax:
Practice Address - Street 1:3150 SHEYENNE ST STE 240
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8546
Practice Address - Country:US
Practice Address - Phone:701-364-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR43831363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics