Provider Demographics
NPI:1760060909
Name:DEPASUPIL, JOANNA IRIS AVENA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA IRIS
Middle Name:AVENA
Last Name:DEPASUPIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FOREST RIDGE RD APT 233
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-6126
Mailing Address - Country:US
Mailing Address - Phone:603-553-6753
Mailing Address - Fax:
Practice Address - Street 1:3 FOREST RIDGE RD APT 233
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-6126
Practice Address - Country:US
Practice Address - Phone:603-553-6753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program