Healthcare Provider Details

I. General information

NPI: 1104642990
Provider Name (Legal Business Name): EMMA ANN SNAVELY MS, LCGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PARDEE CANCER WELLNESS CENTER 4201 CAMPUS RIDGE DRIVE
MIDLAND MI
48670-0001
US

IV. Provider business mailing address

2414 SWEDE AVE APT 1201
MIDLAND MI
48642-4939
US

V. Phone/Fax

Practice location:
  • Phone: 989-794-0320
  • Fax: 989-839-1458
Mailing address:
  • Phone: 319-457-0484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number7201000587
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: