Healthcare Provider Details

I. General information

NPI: 1306808126
Provider Name (Legal Business Name): BEVERLY MARIE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 422
APO AE
09042
DE

IV. Provider business mailing address

CMR 442
APO AE
09042
DE

V. Phone/Fax

Practice location:
  • Phone: 622-117-2274
  • Fax:
Mailing address:
  • Phone: 622-117-2274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number1755
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: