Healthcare Provider Details

I. General information

NPI: 1770573040
Provider Name (Legal Business Name): JENNIFER L SNYDER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8984 E US HIGHWAY 20
NEW CARLISLE IN
46552-9038
US

IV. Provider business mailing address

8984 E US HIGHWAY 20
NEW CARLISLE IN
46552-9038
US

V. Phone/Fax

Practice location:
  • Phone: 574-654-8490
  • Fax: 574-654-3643
Mailing address:
  • Phone: 574-654-8490
  • Fax: 574-654-3643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000693A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: