Healthcare Provider Details

I. General information

NPI: 1932533064
Provider Name (Legal Business Name): K SNYDER ANESTHESIA SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 DUBOIS DR
WARSAW IN
46580-3212
US

IV. Provider business mailing address

PO BOX 1296
WARSAW IN
46581-1296
US

V. Phone/Fax

Practice location:
  • Phone: 574-269-2777
  • Fax:
Mailing address:
  • Phone: 574-268-9640
  • Fax: 574-268-0684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN M SNYDER
Title or Position: OWNER
Credential: CRNA
Phone: 317-565-1264