MEDICARE: DANIELLA MARIE DEPERI PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA.0007924	CO

General Provider Information

NPI Number	:	1750553152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLA MARIE DEPERI PA-C

Provider Business Mailing Address
First Line	:	2918 S TIMBERLINE RD APT 5-201
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4682
Country	:	US
Telephone Number	:	854-444-9702
Fax Number	:

Provider Business Practice Location Address
First Line	:	3726 S TIMBERLINE RD STE 101
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4332
Country	:	US
Telephone Number	:	970-221-5795
Fax Number	:	970-221-1371

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2008
Last Update Date	:	03/03/2025

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