MEDICARE: MRS. MICHELE CHRISTINE COURNAN ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	F301861	NY
2	364SR0400X	Rehabilitation Clinical Nurse Specialist	416257	NY
3	363L00000X	Nurse Practitioner	301861	NY

General Provider Information

NPI Number	:	1639174626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELE CHRISTINE COURNAN ANP

Provider Business Mailing Address
First Line	:	PO BOX 14890
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12212-4890
Country	:	US
Telephone Number	:	518-525-5634
Fax Number	:

Provider Business Practice Location Address
First Line	:	1270 BELMONT AVE
Second Line	:
City	:	SCHENECTADY
State	:	NY
Zip	:	12308-2104
Country	:	US
Telephone Number	:	518-386-3512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	05/13/2021

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