MEDICARE: BROOKE DANIELLE SNIDER FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71009154A	IN
2	363LF0000X	Family Nurse Practitioner	28177094A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28177094A	OTHER	IN	NURSING LICENSE

General Provider Information

NPI Number	:	1043872625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE DANIELLE SNIDER FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 637764
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-7764
Country	:	US
Telephone Number	:	317-880-3939
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 KESSLER BOULEVARD EAST DR STE 210
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2889
Country	:	US
Telephone Number	:	317-880-2276
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2019
Last Update Date	:	09/30/2025

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