Healthcare Provider Details

I. General information

NPI: 1003339235
Provider Name (Legal Business Name): CORA ANN SNYDERS RN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 MANCHESTER RD
BRENTWOOD MO
63144-2602
US

IV. Provider business mailing address

1107 MISSISSIPPI AVE APT 504
SAINT LOUIS MO
63104-2466
US

V. Phone/Fax

Practice location:
  • Phone: 314-963-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2016044695
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: