Provider Demographics
NPI:1912160854
Name:DECKER, ELIZABETH EASLEY (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:EASLEY
Last Name:DECKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:EASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1867 AIRPORT WAY STE 120B
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4071
Mailing Address - Country:US
Mailing Address - Phone:907-457-5050
Mailing Address - Fax:907-457-5034
Practice Address - Street 1:1867 AIRPORT WAY STE 120B
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4071
Practice Address - Country:US
Practice Address - Phone:907-457-5050
Practice Address - Fax:907-457-5034
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPADA1071363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant