Provider Demographics
NPI:1902860265
Name:DECKER, CONNIE (CRNP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:DECKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 JAYCEE DRIVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3650
Mailing Address - Country:US
Mailing Address - Phone:724-349-2022
Mailing Address - Fax:
Practice Address - Street 1:136 JAYCEE DRIVE
Practice Address - Street 2:SUITE 10
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3650
Practice Address - Country:US
Practice Address - Phone:724-349-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP004802G363LX0001X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology