Healthcare Provider Details

I. General information

NPI: 1902996168
Provider Name (Legal Business Name): MARSHA DANIELS SNYDER PHD,APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MILE SQUARE HEALTH CENTER , 2045 W. WASHINGTON BLVD. IHC, 2ND FLOOR, FAMILY MEDICINE
CHICAGO IL
60612
US

IV. Provider business mailing address

UIC COLLEGE OF NURSING (MC802) 845 S. DAMEN AVE. PMA DEPARTMENT, SUITE 1022
CHICAGO IL
60612-7350
US

V. Phone/Fax

Practice location:
  • Phone: 312-355-3504
  • Fax: 312-413-3664
Mailing address:
  • Phone: 312-996-8011
  • Fax: 312-996-7725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number209001707
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: