Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F330649-1 | NY |
NPI | 1003150533 |
---|---|
Provider Name | Diane F. Snyder |
First Address | Marcellus, NY 13108-1131 |
Second Address | Marcellus, NY 13108-1131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2012 |
Last Update Date | 21/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E81169 | (02) | NY |
MS0171164 | DEA (01) | NY |