Healthcare Provider Details

I. General information

NPI: 1215597471
Provider Name (Legal Business Name): MARIA GEBREMICHAEL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LAWRENCE ST
GLENS FALLS NY
12801-3617
US

IV. Provider business mailing address

532 MOE RD
CLIFTON PARK NY
12065-3822
US

V. Phone/Fax

Practice location:
  • Phone: 518-798-9985
  • Fax:
Mailing address:
  • Phone: 518-383-2425
  • Fax: 518-383-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344565
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: