Healthcare Provider Details

I. General information

NPI: 1760824973
Provider Name (Legal Business Name): KATHY SNYDER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30204 GEBHART PL
WILLOWICK OH
44095-4915
US

IV. Provider business mailing address

PO BOX 5292
WILLOWICK OH
44095-0292
US

V. Phone/Fax

Practice location:
  • Phone: 440-391-8202
  • Fax:
Mailing address:
  • Phone: 440-391-8202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number124842
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: