Basic Information
| Provider Information | |||||||||
| NPI: | 1407825003 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DECKER-MILLER | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CNM | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DECKER | ||||||||
| OtherFirstName: | NANCY | ||||||||
| OtherMiddleName: | JEAN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | CNM | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5700 BOTTINEAU BLVD | ||||||||
| Address2: | #210 | ||||||||
| City: | CRYSTAL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635877000 | ||||||||
| FaxNumber: | 7635877015 | ||||||||
| Practice Location | |||||||||
| Address1: | 9825 HOSPITAL DR | ||||||||
| Address2: | #205 | ||||||||
| City: | MAPLE GROVE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635877000 | ||||||||
| FaxNumber: | 7635877015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 11/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | R127886-0 | MN | Y | Other Service Providers | Midwife |
No ID Information.