Provider Demographics
NPI:1861208191
Name:DECKER, ROSEANNE MARIE (LPN)
Entity type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:MARIE
Last Name:DECKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4566
Mailing Address - Country:US
Mailing Address - Phone:814-312-1449
Mailing Address - Fax:
Practice Address - Street 1:3438 ROUTE 764
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-7803
Practice Address - Country:US
Practice Address - Phone:814-944-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN3138565207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine