Healthcare Provider Details

I. General information

NPI: 1295835973
Provider Name (Legal Business Name): LISA SNYDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6971 COUNTY ROAD 121
MOUNT GILEAD OH
43338-9554
US

IV. Provider business mailing address

6971 COUNTY ROAD 121
MOUNT GILEAD OH
43338-9554
US

V. Phone/Fax

Practice location:
  • Phone: 614-622-9116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number300470
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: