Basic Information
Provider Information
NPI: 1033441431
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARNAK
FirstName: EMILY
MiddleName: LYNN
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1735 S PUBLIC RD STE 203
Address2:  
City: LAFAYETTE
State: CO
PostalCode: 800267093
CountryCode: US
TelephoneNumber: 3036653036
FaxNumber: 3036653397
Practice Location
Address1: 2525 13TH ST
Address2:  
City: BOULDER
State: CO
PostalCode: 803044104
CountryCode: US
TelephoneNumber: 3034496050
FaxNumber: 7205654132
Other Information
ProviderEnumerationDate: 02/10/2010
LastUpdateDate: 05/17/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/17/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XPA.0002899COY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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