Healthcare Provider Details

I. General information

NPI: 1548638778
Provider Name (Legal Business Name): ANDRAELLE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4209 GENEVA RD
SAINT LOUIS MI
48880-9337
US

IV. Provider business mailing address

4209 GENEVA RD
SAINT LOUIS MI
48880-9337
US

V. Phone/Fax

Practice location:
  • Phone: 989-495-6814
  • Fax:
Mailing address:
  • Phone: 989-495-6814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: