Provider Demographics
NPI:1588482459
Name:DECKER, ALANA MARIE
Entity type:Individual
Prefix:
First Name:ALANA
Middle Name:MARIE
Last Name:DECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALANA
Other - Middle Name:MARIE
Other - Last Name:POLSFUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 ALGOMA BLVD
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-8610
Mailing Address - Country:US
Mailing Address - Phone:920-424-1234
Mailing Address - Fax:
Practice Address - Street 1:644 PROSPECT AVE # 152
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53006-2629
Practice Address - Country:US
Practice Address - Phone:612-240-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI242318-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse