Provider Demographics
NPI:1043629405
Name:DECKER, REBECCA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:DECKER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9897 S BRANDLEY RD
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-9707
Mailing Address - Country:US
Mailing Address - Phone:405-213-8353
Mailing Address - Fax:
Practice Address - Street 1:9897 S BRANDLEY RD
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-9707
Practice Address - Country:US
Practice Address - Phone:405-213-8353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-10
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK80497163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant