Provider Demographics
NPI:1912768110
Name:DECKER, CATHERINE (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:DECKER
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 W KINGMAN LOOP
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5119
Mailing Address - Country:US
Mailing Address - Phone:520-709-1231
Mailing Address - Fax:
Practice Address - Street 1:631 W KINGMAN LOOP
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5119
Practice Address - Country:US
Practice Address - Phone:520-709-1231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY873390133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered