Provider Demographics
NPI:1518047273
Name:EASTMAN, MICHELLE L (NNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:NNP
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Other - Credentials:
Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALNG
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-6992
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:100 PARK ST
Practice Address - Street 2:PEDIATRIC HOSPITALIST PROGRAM OF GLENS FALLS HOSPITAL
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4413
Practice Address - Country:US
Practice Address - Phone:518-926-5925
Practice Address - Fax:518-926-5917
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-06-07
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Provider Licenses
StateLicense IDTaxonomies
NY350207363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03767333Medicaid