Healthcare Provider Details

I. General information

NPI: 1821922071
Provider Name (Legal Business Name): COURTNEY DIETRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 FAIRVIEW AVE STE 200
HUDSON NY
12534-1048
US

IV. Provider business mailing address

446 FAIRVIEW AVE STE 200
HUDSON NY
12534-1048
US

V. Phone/Fax

Practice location:
  • Phone: 518-267-3496
  • Fax:
Mailing address:
  • Phone: 518-267-3496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number359275
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: