MEDICARE: MARY ANN SNYDER CLARK CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	SP008753	PA
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	SP008753	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	102499	OTHER	PA	JOHNS HOPKINS
2	1551918	OTHER	PA	GATEWAY-WMG
3	50054751	OTHER	PA	CAPITAL BLUE CROSS-WMG
4	648377	OTHER	MD	CAREFIRST MD BCBS

General Provider Information

NPI Number	:	1629006010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN SNYDER CLARK CRNP

Provider Business Mailing Address
First Line	:	1803 MOUNT ROSE AVE
Second Line	:	SUITE B3
City	:	YORK
State	:	PA
Zip	:	17403-3026
Country	:	US
Telephone Number	:	717-851-1405
Fax Number	:	717-851-6162

Provider Business Practice Location Address
First Line	:	300 PINE GROVE COMMONS
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17403-5176
Country	:	US
Telephone Number	:	717-851-5736
Fax Number	:	717-851-6162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	06/10/2016

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