Provider Demographics
NPI:1851409478
Name:DITTNER, DEBORAH L (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:DITTNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0304
Mailing Address - Country:US
Mailing Address - Phone:518-926-1720
Mailing Address - Fax:518-926-1921
Practice Address - Street 1:6 CARPENTER LN
Practice Address - Street 2:A WOMAN'S VIEW
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5521
Practice Address - Country:US
Practice Address - Phone:518-926-1720
Practice Address - Fax:518-926-1721
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02776401Medicaid