Provider Demographics
NPI:1346631637
Name:EMERSON, SUSAN A (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:EMERSON
Suffix:
Gender:F
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 1:1949 PEARL SR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4496
Mailing Address - Country:US
Mailing Address - Phone:303-449-0517
Mailing Address - Fax:303-449-0634
Practice Address - Street 1:1949 PEARL SR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4496
Practice Address - Country:US
Practice Address - Phone:303-449-0517
Practice Address - Fax:303-449-0634
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004221363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical