Healthcare Provider Details

I. General information

NPI: 1922376094
Provider Name (Legal Business Name): STEPHANIE SNYDER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST SUITE 710
CHICAGO IL
60612-3841
US

IV. Provider business mailing address

2307 W ROSCOE ST APARTMENT 1W
CHICAGO IL
60618-6245
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-4036
  • Fax: 312-942-4168
Mailing address:
  • Phone: 847-987-6732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209009277
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: