Healthcare Provider Details

I. General information

NPI: 1992723092
Provider Name (Legal Business Name): DIANE E BELANGER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2554 RT 9
BALLSTON SPA NY
12020
US

IV. Provider business mailing address

2554 RT 9
BALLSTON SPA NY
12020
US

V. Phone/Fax

Practice location:
  • Phone: 518-899-5002
  • Fax: 518-899-5840
Mailing address:
  • Phone: 518-899-5002
  • Fax: 518-899-5840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number331787
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: