Individual
MRS. MARY LOU SNOUFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1234 E DUPONT RD # PPG, FORT WAYNE, IN 46825-1545
(260) 373-9728
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
(260) 266-6013
Taxonomy
Speciality
Code
Description
License number
State
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
71003613A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000724410
ANTHEM
IN
05
—
201023150
—
IN
Enumeration date
05/26/2011
Last updated
03/10/2021
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