Healthcare Provider Details

I. General information

NPI: 1427380344
Provider Name (Legal Business Name): DONNA SUE SNYDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 STILLWATER WOODS DR
FENTON MO
63026-5165
US

IV. Provider business mailing address

150 STILLWATER WOODS DR
FENTON MO
63026-5165
US

V. Phone/Fax

Practice location:
  • Phone: 636-305-1901
  • Fax:
Mailing address:
  • Phone: 636-305-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number136609
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: