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General NPI Number Information
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NPI Number | 1760688204
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Entity Type | Individual
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Provider Name | JENNIFER BRAE SNAVELY DO
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Gender | Female
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 11/12/2018
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Provider Practice Location Address
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Address Line | 313 LOGAN AVE
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City | STATE COLLEGE
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State | PA
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Zip | 16801-4623
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Country | US
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Telephone | 814-206-9944
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Fax | 224-235-4652
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Provider Business Mailing Address
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Address Line | PO BOX 791
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City | NORTHBROOK
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State | IL
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Zip | 60065-0791
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Country | US
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Telephone | 847-593-8460
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Fax | 224-235-4652
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OT011584
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0S014357
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License Number State | PA
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