Hannah Nicole Decker, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50-002804 Issued in OH

Practice address

14601 Detroit Ave
Suite 400
Lakewood, OH 44107-4214

Phone

(216) 226-8700

Fax

(216) 221-3171

NPI assigned

Mar 10, 2009

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

Other names 1

• Hannah Nicole Colgrove Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ko Nurse Practitioner, LLC

  • Nurse Practitioner
  • Lakewood, OH
  • NPI 1912287624

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1236643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323302400000",
    "number": "1265673925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24651 CENTER RIDGE RD",
            "address_2": "SUITE 350",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441455635",
            "telephone_number": "440-895-5056",
            "fax_number": "440-333-2935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14601 DETROIT AVE",
            "address_2": "SUITE 400",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441074214",
            "telephone_number": "216-226-8700",
            "fax_number": "216-221-3171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECKER",
        "first_name": "HANNAH",
        "middle_name": "NICOLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-10",
        "last_updated": "2011-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50-002804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HANNAH",
            "last_name": "COLGROVE",
            "middle_name": "NICOLE",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David T Jonke DDS Inc
• Ann Davis, P.T.
• Douglas Davis
• Latoria Davis, QMHS
• Christine Ann Dearth, CNP
• Genaro Alejandro Deleon, MD
• Dalisa Delk, R.N
• Denver D Jenkins Jr DDS Inc
• Ann L Devaty Kiraly, LPCC
• Gregory P Devor, D.D.S.

• Physician Assistant in Lakewood, OH
• Providers in Lakewood, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; 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.