Healthcare Provider Details

I. General information

NPI: 1801352612
Provider Name (Legal Business Name): RACHEL C SNIDER RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2019
Last Update Date: 02/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 JENNINGS PL
CHILLICOTHEE MO
64601-1960
US

IV. Provider business mailing address

1710 JENNINGS PL
CHILLICOTHEE MO
64601-1960
US

V. Phone/Fax

Practice location:
  • Phone: 660-247-5653
  • Fax:
Mailing address:
  • Phone: 660-247-5653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number2017019405
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: