Provider Demographics
NPI:1073274304
Name:EPP, HANS HUENEFELD (PA-C)
Entity Type:Individual
Prefix:
First Name:HANS
Middle Name:HUENEFELD
Last Name:EPP
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 S POTOMAC ST STE 110
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5433
Mailing Address - Country:US
Mailing Address - Phone:720-324-4777
Mailing Address - Fax:
Practice Address - Street 1:4672 W 20TH STREET RD UNIT 1023
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-8400
Practice Address - Country:US
Practice Address - Phone:402-604-1785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-08
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
COPA.0007494363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program