Provider Demographics
NPI:1467837534
Name:DECKER, MICAYLA
Entity type:Individual
Prefix:
First Name:MICAYLA
Middle Name:
Last Name:DECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4688 REED HILL RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:NY
Mailing Address - Zip Code:14821-9740
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4688 REED HILL RD
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:NY
Practice Address - Zip Code:14821-9740
Practice Address - Country:US
Practice Address - Phone:607-368-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322632164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse