Amanda Decker

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

L074677-5 Issued in MN

Practice address

3102 25TH St SW
Waverly, MN 55390-5043

Phone

(612) 702-9300

NPI assigned

Feb 9, 2016

Last updated

Feb 9, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454976000000",
    "number": "1053779769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3102 25TH ST SW",
            "city": "WAVERLY",
            "state": "MN",
            "postal_code": "553905043",
            "telephone_number": "612-702-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3102 25TH ST SW",
            "city": "WAVERLY",
            "state": "MN",
            "postal_code": "553905043",
            "telephone_number": "612-702-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECKER",
        "first_name": "AMANDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-09",
        "last_updated": "2016-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MN",
            "license": "L074677-5",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adjust to Wellness, PLLC
• Andrea Zitzloff (Andrea's Massage Therapy)
• Sarah Suzann Bartosch, D.C.
• C10202017363071 (Eosis)
• Early Bird Outcomes, Inc.
• Emf Webz LLC
• Cindy Grangroth
• Candace Latanya Hanson, M.A., LPCC
• Timarie Leahy, RN

• Licensed Practical Nurse in Waverly, MN
• Providers in Waverly, MN by specialty
• Licensed Practical Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.