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 1:1118 E US HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-8013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5590 JENNIFER LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-1419
Practice Address - Country:US
Practice Address - Phone:316-655-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0008551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant