Provider Demographics
NPI:1184496515
Name:BRIAN J. DECKER, MSN, FNPC, PC
Entity type:Organization
Organization Name:BRIAN J. DECKER, MSN, FNPC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:208-403-4140
Mailing Address - Street 1:3863 E 300 N
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5423
Mailing Address - Country:US
Mailing Address - Phone:208-403-4140
Mailing Address - Fax:
Practice Address - Street 1:3863 E 300 N
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5423
Practice Address - Country:US
Practice Address - Phone:208-403-4140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health