MEDICARE: COURTNEY DIETRICH

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	363LF0000X	Family Nurse Practitioner	359275	NY

General Provider Information

NPI Number	:	1821922071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY DIETRICH

Provider Business Mailing Address
First Line	:	446 FAIRVIEW AVE STE 200
Second Line	:
City	:	HUDSON
State	:	NY
Zip	:	12534-1048
Country	:	US
Telephone Number	:	518-267-3496
Fax Number	:

Provider Business Practice Location Address
First Line	:	446 FAIRVIEW AVE STE 200
Second Line	:
City	:	HUDSON
State	:	NY
Zip	:	12534-1048
Country	:	US
Telephone Number	:	518-267-3496
Fax Number	:

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

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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Directions to “ COURTNEY DIETRICH ” Practice Location

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