Provider Demographics
NPI:1982062337
Name:AGWU, EMMANUELA
Entity type:Individual
Prefix:
First Name:EMMANUELA
Middle Name:
Last Name:AGWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:N
Other - Last Name:AGWU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:755 HERITAGE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3600
Mailing Address - Country:US
Mailing Address - Phone:303-277-0700
Mailing Address - Fax:303-277-0714
Practice Address - Street 1:755 HERITAGE RD
Practice Address - Street 2:STE 100
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3600
Practice Address - Country:US
Practice Address - Phone:303-277-0700
Practice Address - Fax:303-277-0714
Is Sole Proprietor?:No
Enumeration Date:2016-01-31
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN0992160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily