Healthcare Provider Details

I. General information

NPI: 1932706660
Provider Name (Legal Business Name): GREGORY DANIEL SNYDER CRNP, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MOUNTAIN DR
WILKES BARRE PA
18711-0027
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-808-4772
  • Fax: 570-808-6174
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP022621
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: