Healthcare Provider Details

I. General information

NPI: 1548652886
Provider Name (Legal Business Name): SUSAN SNIDER MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N EDDY ST
SOUTH BEND IN
46617-3096
US

IV. Provider business mailing address

211 N EDDY ST
SOUTH BEND IN
46617-3096
US

V. Phone/Fax

Practice location:
  • Phone: 574-234-4100
  • Fax:
Mailing address:
  • Phone: 574-234-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28114308A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: