Provider Demographics
NPI:1225233638
Name:DEPETE, JESSICA (RAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DEPETE
Suffix:
Gender:F
Credentials:RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2202
Mailing Address - Country:US
Mailing Address - Phone:570-801-1369
Mailing Address - Fax:
Practice Address - Street 1:310 N 7TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2202
Practice Address - Country:US
Practice Address - Phone:570-801-1369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAKO000566171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist