Healthcare Provider Details

I. General information

NPI: 1376809939
Provider Name (Legal Business Name): MARY F SNYDER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 KENNEDY PKWY
CORTLAND NY
13045-1409
US

IV. Provider business mailing address

2859 E FREETOWN TEXAS VALLEY RD
CINCINNATUS NY
13040-3111
US

V. Phone/Fax

Practice location:
  • Phone: 607-753-9105
  • Fax:
Mailing address:
  • Phone: 607-836-6272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number461870-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: