Healthcare Provider Details

I. General information

NPI: 1801560248
Provider Name (Legal Business Name): STACI RENAE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2021
Last Update Date: 09/12/2021
Certification Date: 09/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FAIRFIELD DR
SENECA PA
16346-2130
US

IV. Provider business mailing address

100 FAIRFIELD DR
SENECA PA
16346-2130
US

V. Phone/Fax

Practice location:
  • Phone: 814-676-7713
  • Fax:
Mailing address:
  • Phone: 814-316-1171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number649640
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP024370
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: