Healthcare Provider Details

I. General information

NPI: 1164252185
Provider Name (Legal Business Name): ADAM SNIDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W CENTRAL AVE STE 200
TOLEDO OH
43606-3817
US

IV. Provider business mailing address

3000 ARLINGTON AVE STOP 1108
TOLEDO OH
43614-2595
US

V. Phone/Fax

Practice location:
  • Phone: 567-420-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0037674
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN413867
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: