Provider Demographics
NPI:1770573040
Name:SNYDER, JENNIFER L (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SNYDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8984 E US HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:IN
Mailing Address - Zip Code:46552-9038
Mailing Address - Country:US
Mailing Address - Phone:574-654-8490
Mailing Address - Fax:574-654-3643
Practice Address - Street 1:8984 E US HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:IN
Practice Address - Zip Code:46552-9038
Practice Address - Country:US
Practice Address - Phone:574-654-8490
Practice Address - Fax:574-654-3643
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000693A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN146470VVVVMedicare ID - Type Unspecified
INP11432Medicare UPIN