Basic Information
Provider Information
NPI: 1003150533
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SNYDER
FirstName: DIANE
MiddleName: F.
NamePrefix:  
NameSuffix:  
Credential: RN-FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MORGAN
OtherFirstName: DIANE
OtherMiddleName: F.
OtherNamePrefix: MS.
OtherNameSuffix:  
OtherCredential: R.N.
OtherLastNameType: 1
Mailing Information
Address1: 27 W. MAIN ST
Address2:  
City: MARCELLUS
State: NY
PostalCode: 131081131
CountryCode: US
TelephoneNumber: 3156734364
FaxNumber:  
Practice Location
Address1: 27 W. MAIN ST
Address2:  
City: MARCELLUS
State: NY
PostalCode: 131081131
CountryCode: US
TelephoneNumber: 3156734364
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/21/2012
LastUpdateDate: 11/21/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X200020NYN Nursing Service ProvidersRegistered Nurse 
363LF0000XF330649-1NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
MS017116401NYDEAOTHER


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