Provider Demographics
NPI:1225365968
Name:EMME, SIEGFRIED JOSE
Entity Type:Individual
Prefix:
First Name:SIEGFRIED
Middle Name:JOSE
Last Name:EMME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SIEGFRIED
Other - Middle Name:J
Other - Last Name:EMME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:4105 PLUM CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8722
Mailing Address - Country:US
Mailing Address - Phone:970-227-0526
Mailing Address - Fax:
Practice Address - Street 1:1025 PENNOCK PL STE 121
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3257
Practice Address - Country:US
Practice Address - Phone:970-495-8980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6012363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81078323Medicaid
CO81078323Medicaid
COCO306502Medicare PIN