Provider Demographics
NPI:1770752446
Name:DECKER, KAREN ANN (MS, RD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:DECKER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MADISON RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5441
Mailing Address - Country:US
Mailing Address - Phone:805-443-1033
Mailing Address - Fax:805-443-1033
Practice Address - Street 1:8 GROVE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7797
Practice Address - Country:US
Practice Address - Phone:805-443-1033
Practice Address - Fax:805-443-1033
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR547876133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered