Healthcare Provider Details

I. General information

NPI: 1396101283
Provider Name (Legal Business Name): GINA SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 N CRYSTAL RD
VESTABURG MI
48891-8706
US

IV. Provider business mailing address

1122 S SENATOR RD
CRYSTAL MI
48818-9744
US

V. Phone/Fax

Practice location:
  • Phone: 989-339-6297
  • Fax:
Mailing address:
  • Phone: 989-339-6297
  • 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: