Provider Demographics
NPI:1124016969
Name:SNELSON, JACQUELINE G (CRNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:G
Last Name:SNELSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MAPLE ST
Mailing Address - Street 2:PO BOX 120
Mailing Address - City:FRIENDSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21531-2122
Mailing Address - Country:US
Mailing Address - Phone:301-746-4160
Mailing Address - Fax:301-746-4161
Practice Address - Street 1:250 MAPLE ST
Practice Address - Street 2:
Practice Address - City:FRIENDSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21531-2122
Practice Address - Country:US
Practice Address - Phone:301-746-4160
Practice Address - Fax:301-746-4161
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO39657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDSO95773UMedicare PIN
MDS46228Medicare UPIN