Healthcare Provider Details

I. General information

NPI: 1518665348
Provider Name (Legal Business Name): ERICA SNYDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERICA SPADE PA-C

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E CHERRY ST
BLUFFTON IN
46714-2002
US

IV. Provider business mailing address

6920 POINTE INVERNESS WAY STE 200
FORT WAYNE IN
46804-7934
US

V. Phone/Fax

Practice location:
  • Phone: 260-824-3500
  • Fax:
Mailing address:
  • Phone: 604-793-5132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10003721A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: