Healthcare Provider Details

I. General information

NPI: 1417170093
Provider Name (Legal Business Name): EMMARENTIA HEYSTEK M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14301 E HAMPDEN AVE
AURORA CO
80014-3902
US

IV. Provider business mailing address

11059 E BETHANY DR 200
AURORA CO
80014-2622
US

V. Phone/Fax

Practice location:
  • Phone: 303-617-2600
  • 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: