Provider Demographics
NPI:1972136323
Name:DECKER, GINA (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:DECKER
Suffix:
Gender:
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:20 SANDHILL DR
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-3287
Mailing Address - Country:US
Mailing Address - Phone:603-913-7749
Mailing Address - Fax:
Practice Address - Street 1:80 PALOMINO LN STE 101
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6447
Practice Address - Country:US
Practice Address - Phone:207-907-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1500133V00000X
NH1068133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered