Provider Demographics
NPI:1619714524
Name:DECKER, LINDSAY NICOLE (CRNP)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:NICOLE
Last Name:DECKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:NICOLE
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:917 HENDERSON HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-6215
Mailing Address - Country:US
Mailing Address - Phone:814-657-0629
Mailing Address - Fax:
Practice Address - Street 1:124 HOME DEPOT DR STE D
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-8002
Practice Address - Country:US
Practice Address - Phone:814-437-7266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030049363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily