Healthcare Provider Details

I. General information

NPI: 1790947695
Provider Name (Legal Business Name): BERNADETTE JEAN SNYDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 N EDWARDS AVE
SYRACUSE NY
13206-2208
US

IV. Provider business mailing address

309 N EDWARDS AVE
SYRACUSE NY
13206-2208
US

V. Phone/Fax

Practice location:
  • Phone: 315-432-4414
  • Fax:
Mailing address:
  • Phone: 315-432-4414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number598387
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number271399-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: