Healthcare Provider Details

I. General information

NPI: 1740089648
Provider Name (Legal Business Name): JACQULINE MARIE SNYDER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CLINTON CT
STILLWATER NY
12170-1306
US

IV. Provider business mailing address

6 CLINTON CT
STILLWATER NY
12170-1306
US

V. Phone/Fax

Practice location:
  • Phone: 518-588-5927
  • Fax:
Mailing address:
  • Phone: 518-588-5927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number331093
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: