Healthcare Provider Details

I. General information

NPI: 1851832745
Provider Name (Legal Business Name): DARLA SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 MISSOURI AVE
FORT LEONARD WOOD MO
65473-9098
US

IV. Provider business mailing address

20214 HYATT LN
SAINT ROBERT MO
65584-9448
US

V. Phone/Fax

Practice location:
  • Phone: 573-596-0471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number183392
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: