Provider Demographics
NPI:1326373457
Name:DECKER, SUZANNE MARIE (APN)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:DECKER
Suffix:
Gender:
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 W IRONWOOD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2643
Mailing Address - Country:US
Mailing Address - Phone:208-667-2600
Mailing Address - Fax:208-625-2051
Practice Address - Street 1:920 W IRONWOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2643
Practice Address - Country:US
Practice Address - Phone:208-667-2600
Practice Address - Fax:208-625-2051
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007779363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1598759292Medicaid
IA132380011Medicare Oscar/Certification
IL207707008Medicare Oscar/Certification