Provider Demographics
NPI:1629006010
Name:CLARK, MARY ANN SNYDER (CRNP)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:SNYDER
Last Name:CLARK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARY ANN
Other - Middle Name:E
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6162
Practice Address - Street 1:300 PINE GROVE COMMONS
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5176
Practice Address - Country:US
Practice Address - Phone:717-851-5736
Practice Address - Fax:717-851-6162
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008753363LF0000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102499OtherJOHNS HOPKINS
PA1551918OtherGATEWAY-WMG
PA50054751OtherCAPITAL BLUE CROSS-WMG
MD648377OtherCAREFIRST MD BCBS
PA1551918OtherGATEWAY-WMG
PA50054751OtherCAPITAL BLUE CROSS-WMG
PA096566FLTMedicare PIN