Healthcare Provider Details

I. General information

NPI: 1306399548
Provider Name (Legal Business Name): EMMANUEL NKANSAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2016
Last Update Date: 07/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14705 E HARVARD AVE
AURORA CO
80014-2435
US

IV. Provider business mailing address

14705 E HARVARD AVE
AURORA CO
80014-2435
US

V. Phone/Fax

Practice location:
  • Phone: 720-404-5614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: