Provider Demographics
NPI:1093285868
Name:LEPE, JESSICA (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LEPE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 S 59TH CT
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-1748
Mailing Address - Country:US
Mailing Address - Phone:708-299-6186
Mailing Address - Fax:
Practice Address - Street 1:2340 S HIGHLAND AVE STE 300
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5397
Practice Address - Country:US
Practice Address - Phone:630-261-1210
Practice Address - Fax:630-261-1210
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant