Healthcare Provider Details

I. General information

NPI: 1184480923
Provider Name (Legal Business Name): KOURTNEY JANE SNYDER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KOURTNEY JANE CRUM

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 DELAWARE AVE
MARION OH
43302-6416
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 740-383-7778
  • Fax:
Mailing address:
  • Phone:
  • Fax: 614-544-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.0021044
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: