Provider Demographics
NPI:1760688204
Name:SNAVELY, JENNIFER BRAE (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BRAE
Last Name:SNAVELY
Suffix:
Gender:F
Credentials:DO
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 791
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-0791
Mailing Address - Country:US
Mailing Address - Phone:847-593-8460
Mailing Address - Fax:224-235-4652
Practice Address - Street 1:313 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4623
Practice Address - Country:US
Practice Address - Phone:814-206-9944
Practice Address - Fax:224-235-4652
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT011584207Q00000X
PA0S014357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA130267OtherGEISSINGER
PASN2128627OtherHIGHMARK
PA102398784-0001Medicaid
PA413602OtherUPMC
PASN2128627OtherHIGHMARK
PA166939WFPMedicare PIN