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General NPI Number Information
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NPI Number | 1770876542
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Entity Type | Individual
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Provider Name | MARY LOU SNOUFFER N.P.
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Gender | Female
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 1234 E DUPONT RD # PPG
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City | FORT WAYNE
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State | IN
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Zip | 46825-1545
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Country | US
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Telephone | 260-373-9728
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Fax |
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Provider Business Mailing Address
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Address Line | 11109 PARKVIEW PLAZA DR # 117
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City | FORT WAYNE
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State | IN
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Zip | 46845-1701
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Country | US
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Telephone | 260-266-6013
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Fax |
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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 | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | 71003613A
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License Number State | IN
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