Provider Demographics
NPI:1316960974
Name:DREITLEIN-SIMONE, MICHELE DOROTHY (FNP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:DOROTHY
Last Name:DREITLEIN-SIMONE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:DOROTHY
Other - Last Name:SIMONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-5924
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:100 PARK STREET
Practice Address - Street 2:GLENS FALLS HOSPITAL BEHAVIORAL HEALTH INPATIENT UNIT
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4413
Practice Address - Country:US
Practice Address - Phone:518-926-3265
Practice Address - Fax:518-926-3273
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401039363LP0808X
NYF332325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily