Healthcare Provider Details

I. General information

NPI: 1710908884
Provider Name (Legal Business Name): ANN DYS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 BROAD ST
GLENS FALLS NY
12801-4381
US

IV. Provider business mailing address

84 BROAD ST
GLENS FALLS NY
12801-4381
US

V. Phone/Fax

Practice location:
  • Phone: 518-798-9538
  • Fax: 518-798-9576
Mailing address:
  • Phone: 518-798-9538
  • Fax: 518-798-9576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF330677
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: