Healthcare Provider Details

I. General information

NPI: 1669290151
Provider Name (Legal Business Name): ASHLEY THANH DANG FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BELL TOWER DR
WATERVLIET NY
12189-2333
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-268-6390
  • Fax:
Mailing address:
  • Phone: 518-555-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF354590
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: