Provider Demographics
NPI:1528136686
Name:DEPEDRO, DONNA A (CNM)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:A
Last Name:DEPEDRO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:A
Other - Last Name:TRIPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:784 HERCULES DR STE 110
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-8049
Mailing Address - Country:US
Mailing Address - Phone:802-448-9787
Mailing Address - Fax:802-448-9787
Practice Address - Street 1:24 PENNACOOK ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3554
Practice Address - Country:US
Practice Address - Phone:866-476-1321
Practice Address - Fax:603-621-0097
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000663-1367A00000X
NH066995-23367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077246Medicaid
NH003011601Medicare PIN