Provider Demographics
NPI:1942740246
Name:DEPNER, LUKE
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:DEPNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 SE 30TH PL
Mailing Address - Street 2:APT B
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:149 SE 30TH PL
Practice Address - Street 2:APT B
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2083
Practice Address - Country:US
Practice Address - Phone:412-508-1127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program