Provider Demographics
NPI:1083151559
Name:DEMORIER, EMMA L (PA-C)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:L
Last Name:DEMORIER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:L
Other - Last Name:FAUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4009 BARRETT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6616
Mailing Address - Country:US
Mailing Address - Phone:919-848-0132
Mailing Address - Fax:
Practice Address - Street 1:4009 BARRETT DR STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6616
Practice Address - Country:US
Practice Address - Phone:919-848-0132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-12872363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1083151559Medicaid
VA1083151559Medicaid