Provider Demographics
NPI:1982065991
Name:DECKER, BRANDON JAMES
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:JAMES
Last Name:DECKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 S HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-5908
Mailing Address - Country:US
Mailing Address - Phone:414-376-5577
Mailing Address - Fax:414-762-9927
Practice Address - Street 1:4650 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-5908
Practice Address - Country:US
Practice Address - Phone:414-376-5577
Practice Address - Fax:414-762-9927
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6683-33363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily