Healthcare Provider Details

I. General information

NPI: 1437645769
Provider Name (Legal Business Name): LEAH MARIE SNYDER CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR RM 2820
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

705 RILEY HOSPITAL DR RM 2820
INDIANAPOLIS IN
46202-5109
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-9981
  • Fax: 317-944-0282
Mailing address:
  • Phone: 317-944-9981
  • Fax: 317-944-0282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number75000030A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: