MEDICARE: AMY MARIE YRSHA FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F344881-01	NY

General Provider Information

NPI Number	:	1861048647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MARIE YRSHA FNP-C

Provider Business Mailing Address
First Line	:	6 MEDICAL PARK DR STE 208
Second Line	:
City	:	BALLSTON SPA
State	:	NY
Zip	:	12020-5063
Country	:	US
Telephone Number	:	518-899-9090
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 MEDICAL PARK DR STE 208
Second Line	:
City	:	BALLSTON SPA
State	:	NY
Zip	:	12020-5053
Country	:	US
Telephone Number	:	518-899-9090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2019
Last Update Date	:	08/16/2019

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