Provider Demographics
NPI:1912288960
Name:DECKER, SUSAN WINTERHALTER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:WINTERHALTER
Last Name:DECKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:RENEE
Other - Last Name:WINTERHALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3806 NAUTILUS TRL
Mailing Address - Street 2:
Mailing Address - City:REMINDERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44202-9022
Mailing Address - Country:US
Mailing Address - Phone:610-248-5565
Mailing Address - Fax:
Practice Address - Street 1:6801 BRECKSVILLE RD STE 10
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-5057
Practice Address - Country:US
Practice Address - Phone:216-636-8601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-05
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003154363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical