Provider Demographics
NPI:1689602443
Name:DECKER, SUSAN MCALOON (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MCALOON
Last Name:DECKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 480
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-624-0123
Mailing Address - Fax:612-625-6919
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:516 DELAWARE STREET SE, PWB FIFTH FLOOR, CLINIC 5B
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9223363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01-19385OtherMEDICA CHOICE
MN1596345OtherARAZ
MN01-06279OtherMEDICA PRIMARY
MN126774OtherUCARE
MNHP28846OtherHEALTHPARTNERS
MN1015334OtherPREFERRED ONE
MN15G62DEOtherBCBS
MNP21535Medicare UPIN