Provider Demographics
NPI:1164932323
Name:SNOOK, LISA DAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:SNOOK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:DAWN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:759 SUSQUEHANNA TRL
Mailing Address - Street 2:
Mailing Address - City:WATSONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17777-8109
Mailing Address - Country:US
Mailing Address - Phone:570-538-1240
Mailing Address - Fax:570-538-1257
Practice Address - Street 1:759 SUSQUEHANNA TRL
Practice Address - Street 2:
Practice Address - City:WATSONTOWN
Practice Address - State:PA
Practice Address - Zip Code:17777-8109
Practice Address - Country:US
Practice Address - Phone:570-538-1240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA0595502083A0300X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine