Healthcare Provider Details

I. General information

NPI: 1396799912
Provider Name (Legal Business Name): MS. ANITA RENEE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4542 W SCHUBERT AVE
CHICAGO IL
60639-1936
US

IV. Provider business mailing address

4542 W SCHUBERT AVE
CHICAGO IL
60639-1936
US

V. Phone/Fax

Practice location:
  • Phone: 312-391-6950
  • Fax:
Mailing address:
  • Phone: 312-391-6950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: