Provider Demographics
NPI:1033969498
Name:NIDER, EMI (PA-C)
Entity type:Individual
Prefix:
First Name:EMI
Middle Name:
Last Name:NIDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMI
Other - Middle Name:
Other - Last Name:HAYASHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 S CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81007-5433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 S CRESCENT DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81007-5433
Practice Address - Country:US
Practice Address - Phone:719-595-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0008551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant