Provider Demographics
NPI:1629247994
Name:SNYDER, CAROL ROSS (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ROSS
Last Name:SNYDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-638-1550
Mailing Address - Fax:704-638-1559
Practice Address - Street 1:530 CORPORATE CIRCLE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28147-8074
Practice Address - Country:US
Practice Address - Phone:704-638-1550
Practice Address - Fax:704-638-1559
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC930133363L00000X, 363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1629247994Medicaid