Provider Demographics
NPI:1710357835
Name:BRIXEN, EMMA MEIGGS (PA)
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:MEIGGS
Last Name:BRIXEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:EMMA
Other - Middle Name:VIOLA
Other - Last Name:MEIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3180 WEST ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1722
Mailing Address - Country:US
Mailing Address - Phone:585-394-1442
Mailing Address - Fax:585-394-1257
Practice Address - Street 1:515 UNION AVE STE 157
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-3005
Practice Address - Country:US
Practice Address - Phone:303-439-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007930RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant