Jerome Joseph Dedecker, is a
Registered Nurse based in Seligman, Arizona. Jerome Joseph Dedecker is licensed to practice in Arizona (license number B12876871) and his current practice location is
26827 Fortrock Rd, Seligman, Arizona. He can be reached at his office (for appointments etc.) via phone at
(928) 583-4245.
NPI number for Jerome Joseph Dedecker is 1225603327 and his current mailing address is 26827 Fortrock Rd, Seligman, Arizona. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1225603327.
Provider's Profile
| Full Name | Jerome Joseph Dedecker |
|---|
| Gender | Male |
|---|
| Speciality | Registered Nurse |
|---|
| Location | 26827 Fortrock Rd, Seligman, Arizona |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1225603327
- Provider Enumeration Date: 05/21/2021
- Last Update Date: 05/21/2021
Medical Identifiers
Medical identifiers for Jerome Joseph Dedecker such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1225603327 | NPI | - | NPPES |
| B12876871 | Medicaid | AZ | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 163W00000X | Registered Nurse | B12876871 (Arizona) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jerome Joseph Dedecker is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Jerome Joseph Dedecker,
26827 Fortrock Rd,
Seligman, AZ 86337
Ph: (928) 583-4245 | Jerome Joseph Dedecker,
26827 Fortrock Rd,
Seligman, AZ 86337
Ph: (928) 583-4245 |
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