Provider Demographics
NPI:1528412095
Name:DEPOE, ANN SMITH (CRNP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:SMITH
Last Name:DEPOE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:4469 RED ROCK RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:PA
Practice Address - Zip Code:17814-7606
Practice Address - Country:US
Practice Address - Phone:570-925-6424
Practice Address - Fax:570-925-5852
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016111363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily