Healthcare Provider Details

I. General information

NPI: 1487786588
Provider Name (Legal Business Name): MARY DEBORAH SNYDER WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N HERMAN ST STE CC
GOLDSBORO NC
27530-2971
US

IV. Provider business mailing address

399 BUCK SWAMP RD
GOLDSBORO NC
27530-8030
US

V. Phone/Fax

Practice location:
  • Phone: 919-731-1000
  • Fax:
Mailing address:
  • Phone: 919-734-9269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number114070
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: