Healthcare Provider Details

I. General information

NPI: 1679718712
Provider Name (Legal Business Name): DEBRA MOELLER SNYDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 LIBERTY ST SUITE 2120
PENN YAN NY
14527-1100
US

IV. Provider business mailing address

PO BOX 217 59 MAIN STREET
DRESDEN NY
14441-0217
US

V. Phone/Fax

Practice location:
  • Phone: 315-536-5160
  • Fax: 315-536-5146
Mailing address:
  • Phone: 315-536-9553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number22 3123142
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: