Healthcare Provider Details

I. General information

NPI: 1801267810
Provider Name (Legal Business Name): MARA LYN SNYDER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARA LYN LAGERMAN RN

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 STATE ROUTE 225
HERNDON PA
17830-7324
US

IV. Provider business mailing address

7 DOCK HILL RD
MIDDLEBURG PA
17842-8910
US

V. Phone/Fax

Practice location:
  • Phone: 570-758-3511
  • Fax: 570-758-4736
Mailing address:
  • Phone: 570-837-2123
  • Fax: 570-837-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN628151
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP015526
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: