Provider Demographics
NPI:1144913633
Name:FICHTNER, JULIE ANN
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:FICHTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12803-5632
Mailing Address - Country:US
Mailing Address - Phone:518-260-7943
Mailing Address - Fax:
Practice Address - Street 1:25 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-5882
Practice Address - Country:US
Practice Address - Phone:518-926-7100
Practice Address - Fax:518-563-9001
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY684247-01163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent