Provider Demographics
NPI:1770966657
Name:SNYDER, KATHLEEN A (ANP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:SNYDER
Suffix:
Gender:F
Credentials:ANP
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 230
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-0230
Mailing Address - Country:US
Mailing Address - Phone:585-786-2290
Mailing Address - Fax:585-786-2853
Practice Address - Street 1:2261 STATE ROUTE 19 N
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-9334
Practice Address - Country:US
Practice Address - Phone:585-786-2290
Practice Address - Fax:585-786-2853
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307310-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health