NPI 1366476400 · live from the CMS NPI Registry
Andrea Leigh Decker
Physician Assistant in Burlington, VT. National Provider Identifier 1366476400, active.
NPI record
| NPI | 1366476400 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 111 Colchester Ave, Fahc Emergency Department, Burlington, VT 05401 |
| Practice phone | 802-847-1237 |
| Mailing address | 129 Cobblestone Cir, South Burlington, VT 05403 |
| Enumerated | July 11, 2006 |
| Last updated | December 20, 2021 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant | 363A00000X | 026780 (NY) |
| Physician Assistant primary | 363A00000X | 55-0030650 (VT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.