Provider Demographics
NPI:1851377337
Name:DECK, CHRISTINE A (CNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:A
Last Name:DECK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:A
Other - Last Name:SHIREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITONER
Mailing Address - Street 1:1303 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-8737
Mailing Address - Country:US
Mailing Address - Phone:330-875-3353
Mailing Address - Fax:330-875-2746
Practice Address - Street 1:1303 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641
Practice Address - Country:US
Practice Address - Phone:330-875-3353
Practice Address - Fax:330-875-2746
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH210823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2154476Medicaid
OH2154476Medicaid