Healthcare Provider Details

I. General information

NPI: 1538348065
Provider Name (Legal Business Name): MARIE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 QUINCY AVE
SCRANTON PA
18510-1724
US

IV. Provider business mailing address

3998 FAIR RIDGE DR., SUITE 300
FAIRFAX VA
22033
US

V. Phone/Fax

Practice location:
  • Phone: 570-340-2983
  • Fax:
Mailing address:
  • Phone: 703-295-9360
  • Fax: 703-766-9795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number264267L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: