Healthcare Provider Details

I. General information

NPI: 1275102873
Provider Name (Legal Business Name): EMILY SISA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 PARK MEADOWS DR
LONE TREE CO
80124-5529
US

IV. Provider business mailing address

3530 IVY ST
DENVER CO
80207-1242
US

V. Phone/Fax

Practice location:
  • Phone: 720-707-6914
  • Fax:
Mailing address:
  • Phone: 703-403-5665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-APN.0003040-C-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0996677
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: