Healthcare Provider Details

I. General information

NPI: 1548207939
Provider Name (Legal Business Name): JESSICA L DEPAEPE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11511 NE 10TH ST
BELLEVUE WA
98004-8578
US

IV. Provider business mailing address

PO BOX 24584
SEATTLE WA
98124-0584
US

V. Phone/Fax

Practice location:
  • Phone: 425-502-3000
  • Fax:
Mailing address:
  • Phone: 425-656-4255
  • Fax: 425-656-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMD00038693
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: