Individual
JACKI RENEE DEPANFILIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
104 METOXET ST, SUITE A, RIDGWAY, PA 15853-1932
(814) 772-8122
(814) 772-7278
Mailing address
104 METOXET ST, SUITE A, RIDGWAY, PA 15853-1932
(814) 772-8122
(814) 772-7278
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA055834
PA
Other
Enumeration date
10/23/2012
Last updated
04/27/2016
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