Healthcare Provider Details

I. General information

NPI: 1700433562
Provider Name (Legal Business Name): REBECKA SNIDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 EVERGREEN ST
FAIRBANKS AK
99709-4306
US

IV. Provider business mailing address

1027 EVERGREEN ST
FAIRBANKS AK
99709-4306
US

V. Phone/Fax

Practice location:
  • Phone: 907-451-8164
  • Fax: 907-451-0273
Mailing address:
  • Phone: 907-451-8164
  • Fax: 907-451-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number147280
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: