Healthcare Provider Details

I. General information

NPI: 1336235837
Provider Name (Legal Business Name): GLORIA JEAN SNYDER R. N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 W. HUDSON BLVD.
GASTONIA NC
28052
US

IV. Provider business mailing address

991 W. HUDSON BLVD.
GASTONIA NC
28052
US

V. Phone/Fax

Practice location:
  • Phone: 704-853-5032
  • Fax: 704-853-5188
Mailing address:
  • Phone: 704-853-5032
  • Fax: 704-853-5188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number101323
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 306632
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: