Provider Demographics
NPI:1548845894
Name:DECK FAMILY PRACTICE
Entity type:Organization
Organization Name:DECK FAMILY PRACTICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-489-7100
Mailing Address - Street 1:7111 A ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4283
Mailing Address - Country:US
Mailing Address - Phone:402-489-7100
Mailing Address - Fax:402-489-3249
Practice Address - Street 1:7111 A ST STE 201
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4283
Practice Address - Country:US
Practice Address - Phone:402-489-7100
Practice Address - Fax:402-489-3249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025595500Medicaid
NE39194OtherBCBS - NHCP
NE110806OtherNURSE PRACTITIONER PSYCH/MENTAL HEALTH
NE110806OtherNURSE PRACTITIONER PRIMARY CARE
NE110806OtherNEBRASKA STATE LICENSE
NE113170OtherNEBRASKA STATE LICENSE
NE1144330457OtherINDIVIDUAL NPI
NE1700408481OtherINDIVIDUAL NPI
NE252878OtherMIDLANDS - NHCP