Healthcare Provider Details

I. General information

NPI: 1497107478
Provider Name (Legal Business Name): REBECCA A FRELIGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PARK ST
GLENS FALLS NY
12801-4403
US

IV. Provider business mailing address

PO BOX 304
GLENS FALLS NY
12801-0304
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-6620
  • Fax: 518-926-1954
Mailing address:
  • Phone: 518-926-5924
  • Fax: 518-926-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number646907
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number307863
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: