Healthcare Provider Details

I. General information

NPI: 1962778175
Provider Name (Legal Business Name): WENDYANN ELIZABETH SNAGG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10436 204TH ST
SAINT ALBANS NY
11412-1324
US

IV. Provider business mailing address

109-36 204TH STREET
HOLLIS NY
11423-2829
US

V. Phone/Fax

Practice location:
  • Phone: 718-465-8310
  • Fax:
Mailing address:
  • Phone: 718-465-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number503986-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: