Active NPI
Ellen Decker, RN
- Registered Nurse
- Grand Rapids, MI
National Provider Identifier
1831586593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 4704128078
- Practice address
- 3300 36TH St SE
Grand Rapids, MI 49512-2810 - Phone
- (616) 831-5547
- Fax
- (616) 831-5548
- NPI assigned
- Apr 21, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 4704128078 | MI | Primary |
Addresses
Primary practice location
3300 36TH St SE
Grand Rapids, MI 49512-2810
Mailing address
3300 36TH St SE
Grand Rapids, MI 49512-2810
Phone (616) 831-5547
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704128078 | MI | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429574400000",
"number": "1831586593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3300 36TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495122810",
"telephone_number": "616-831-5547",
"fax_number": "616-831-5548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3300 36TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495122810",
"telephone_number": "616-831-5547",
"fax_number": "616-831-5548"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DECKER",
"first_name": "ELLEN",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-04-21",
"last_updated": "2015-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MI",
"license": "4704128078",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.