Healthcare Provider Details

I. General information

NPI: 1306228184
Provider Name (Legal Business Name): LAURA M. SNYDER CPNP-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NAVARRE PL STE 5550
SOUTH BEND IN
46601-1169
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-2550
  • Fax: 574-647-1129
Mailing address:
  • Phone: 574-647-2129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71005525A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: