Provider Demographics
NPI:1801267810
Name:SNYDER, MARA LYN (CRNP)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:LYN
Last Name:SNYDER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARA
Other - Middle Name:LYN
Other - Last Name:LAGERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:1244 STATE ROUTE 225
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:PA
Practice Address - Zip Code:17830-7324
Practice Address - Country:US
Practice Address - Phone:570-758-3511
Practice Address - Fax:570-758-4736
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN628151163W00000X
PASP015526363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA451792F6KMedicare PIN