Healthcare Provider Details

I. General information

NPI: 1003795048
Provider Name (Legal Business Name): ELIZABETH SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY PLZ
CAPE GIRARDEAU MO
63701-4710
US

IV. Provider business mailing address

1 UNIVERSITY PLZ
CAPE GIRARDEAU MO
63701-4710
US

V. Phone/Fax

Practice location:
  • Phone: 573-651-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: