Healthcare Provider Details

I. General information

NPI: 1568420537
Provider Name (Legal Business Name): SANDY JEAN SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: SANDY JEAN CZARNECKI RN

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WEED ARMY COMMUNITY HOSPITAL BLDG 166
FORT IRWIN CA
92310
US

IV. Provider business mailing address

8829 MONTJOY PL
ELLICOTT CITY MD
21043-8003
US

V. Phone/Fax

Practice location:
  • Phone: 760-380-3114
  • Fax:
Mailing address:
  • Phone: 410-971-2466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR166390
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: