Provider Demographics
NPI:1386884872
Name:DECKARD, MELISSA ELLEN (RN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ELLEN
Last Name:DECKARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ELLEN
Other - Last Name:DECKARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4796D OMAHA BEACH ST
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-1905
Mailing Address - Country:US
Mailing Address - Phone:573-337-0421
Mailing Address - Fax:
Practice Address - Street 1:4796D OMAHA BEACH ST
Practice Address - Street 2:
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-1905
Practice Address - Country:US
Practice Address - Phone:573-337-0421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006038530163W00000X
CA741502163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic