Provider Demographics
NPI:1104539659
Name:DECKER, CHRISTIANNA KAY (FNP-C)
Entity type:Individual
Prefix:
First Name:CHRISTIANNA
Middle Name:KAY
Last Name:DECKER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ENTERPRISE BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3534
Mailing Address - Country:US
Mailing Address - Phone:864-609-4009
Mailing Address - Fax:864-609-4011
Practice Address - Street 1:10 ENTERPRISE BLVD STE 111
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3534
Practice Address - Country:US
Practice Address - Phone:864-609-4009
Practice Address - Fax:864-609-4011
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26875207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC26875OtherSTATE LICENSING BOARD - APRN