Provider Demographics
NPI:1770827669
Name:DECORSE, SALLY ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ANN
Last Name:DECORSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2094 ARNOLD RD
Mailing Address - Street 2:
Mailing Address - City:WINTERHAVEN
Mailing Address - State:CA
Mailing Address - Zip Code:92283-9703
Mailing Address - Country:US
Mailing Address - Phone:818-571-0136
Mailing Address - Fax:
Practice Address - Street 1:2094 ARNOLD RD
Practice Address - Street 2:
Practice Address - City:WINTERHAVEN
Practice Address - State:CA
Practice Address - Zip Code:92283-9703
Practice Address - Country:US
Practice Address - Phone:818-571-0136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA326551163W00000X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult