Provider Demographics
NPI:1003150533
Name:SNYDER, DIANE F (RN-FNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:F
Last Name:SNYDER
Suffix:
Gender:F
Credentials:RN-FNP
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:F
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:27 W. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13108-1131
Mailing Address - Country:US
Mailing Address - Phone:315-673-4364
Mailing Address - Fax:
Practice Address - Street 1:27 W. MAIN ST
Practice Address - Street 2:
Practice Address - City:MARCELLUS
Practice Address - State:NY
Practice Address - Zip Code:13108-1131
Practice Address - Country:US
Practice Address - Phone:315-673-4364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200020163W00000X
NYF330649-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMS0171164OtherDEA
NYE81169Medicare UPIN