Provider Demographics
NPI:1811934664
Name:DAHL, JEANNE ANN (NP)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:ANN
Last Name:DAHL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 NEW SCOTLAND AVE
Mailing Address - Street 2:MC 74 2ND FLOOR
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3555
Mailing Address - Country:US
Mailing Address - Phone:518-262-4942
Mailing Address - Fax:518-262-6904
Practice Address - Street 1:16 NEW SCOTLAND AVE
Practice Address - Street 2:MC 74 2ND FLOOR
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3555
Practice Address - Country:US
Practice Address - Phone:518-262-4942
Practice Address - Fax:518-262-6904
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420053-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY514704Medicare UPIN
NY4715120001Medicare NSC
NYDD6025Medicare ID - Type Unspecified