Healthcare Provider Details

I. General information

NPI: 1053014852
Provider Name (Legal Business Name): EMMA NICOLE THEIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 PURCELL ST
BRIGHTON CO
80601-3551
US

IV. Provider business mailing address

2901 PURCELL ST
BRIGHTON CO
80601-3550
US

V. Phone/Fax

Practice location:
  • Phone: 303-659-9700
  • Fax:
Mailing address:
  • Phone: 303-659-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0008735
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0008735
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: