Healthcare Provider Details

I. General information

NPI: 1366481194
Provider Name (Legal Business Name): BETH ANN SNYDER-PETROWITZ C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 04/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S. OAKLAND
ST. JOHN'S MI
48879
US

IV. Provider business mailing address

6043 DAWN AVE
EAST LANSING MI
48823-5601
US

V. Phone/Fax

Practice location:
  • Phone: 989-224-6881
  • Fax:
Mailing address:
  • Phone: 517-388-1256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704179131
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: