Healthcare Provider Details

I. General information

NPI: 1255152021
Provider Name (Legal Business Name): NICOLE SNYDER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MONUMENT RD
YORK PA
17403-5060
US

IV. Provider business mailing address

108 N CONSTITUTION AVE
NEW FREEDOM PA
17349-9510
US

V. Phone/Fax

Practice location:
  • Phone: 717-741-9229
  • Fax:
Mailing address:
  • Phone: 717-487-6469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP031061
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: