Provider Demographics
NPI:1942748637
Name:DECOU, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DECOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:DECOU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN IBCLC
Mailing Address - Street 1:687 43RD ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1839
Mailing Address - Country:US
Mailing Address - Phone:503-502-1037
Mailing Address - Fax:
Practice Address - Street 1:687 43RD ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1839
Practice Address - Country:US
Practice Address - Phone:503-502-1037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA636090163WL0100X
OR198-14591163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant