Provider Demographics
NPI:1962864959
Name:DECKER-ST ONGE, NICHOLE LEE (MSN, CRNA, APRN)
Entity Type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:LEE
Last Name:DECKER-ST ONGE
Suffix:
Gender:F
Credentials:MSN, CRNA, APRN
Other - Prefix:MS
Other - First Name:NICHOLE
Other - Middle Name:LEE
Other - Last Name:DECKER-FARIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN, SRNA
Mailing Address - Street 1:22 BRAMHALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3134
Mailing Address - Country:US
Mailing Address - Phone:207-662-2526
Mailing Address - Fax:207-662-6236
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-2526
Practice Address - Fax:207-662-6236
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERNA173026367500000X
MER059846390200000X
MARN2301816390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered