1366807372 NPI number — SUSAN CAMPBELL SNYDER CRNP

Table of content: SUSAN CAMPBELL SNYDER CRNP (NPI 1366807372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366807372 NPI number — SUSAN CAMPBELL SNYDER CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNYDER
Provider First Name:
SUSAN
Provider Middle Name:
CAMPBELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SNYDER
Provider Other First Name:
SUSAN
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1366807372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 PHILADELPHIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHILLINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19607-2764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-777-7841
Provider Business Mailing Address Fax Number:
610-775-7198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 PHILADELPHIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHILLINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-777-7841
Provider Business Practice Location Address Fax Number:
610-775-7198
Provider Enumeration Date:
12/17/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  SP015342 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LG0600X , with the licence number: SP015342 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1366807372 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".