Healthcare Provider Details

I. General information

NPI: 1467265405
Provider Name (Legal Business Name): SAMANTHA RENEE SNYDER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 THE MEADOWS DR
CENTRE HALL PA
16828-9231
US

IV. Provider business mailing address

365 SALEM RD
SELINSGROVE PA
17870-7807
US

V. Phone/Fax

Practice location:
  • Phone: 814-364-2161
  • Fax:
Mailing address:
  • Phone: 570-259-9119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP031710
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: