Healthcare Provider Details

I. General information

NPI: 1558583120
Provider Name (Legal Business Name): BETH PHYLLIS SNYDER RN, CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT STREET GRB 800
BOSTON MA
02114
US

IV. Provider business mailing address

55 FRUIT STREET GRB 800
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-6742
  • Fax:
Mailing address:
  • Phone: 617-726-6742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number205770
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: