Provider Demographics
NPI:1881204295
Name:DECKRO, JOHN (DNP, ANP-BC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DECKRO
Suffix:
Gender:M
Credentials:DNP, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2304
Mailing Address - Country:US
Mailing Address - Phone:617-543-4881
Mailing Address - Fax:
Practice Address - Street 1:50 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-2304
Practice Address - Country:US
Practice Address - Phone:617-543-4881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-01
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN163432363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health