Provider Demographics
NPI:1467020644
Name:WILLMANN, EMILY QUADE (AGNP-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:QUADE
Last Name:WILLMANN
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 KOLAR CT
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-6856
Mailing Address - Country:US
Mailing Address - Phone:720-438-0259
Mailing Address - Fax:
Practice Address - Street 1:8820 HURON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-6805
Practice Address - Country:US
Practice Address - Phone:303-386-7622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0996570363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care