Healthcare Provider Details

I. General information

NPI: 1184877953
Provider Name (Legal Business Name): TOMOKO SNYDER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RESERVOIR AVE STE 103
CRANSTON RI
02910-4451
US

IV. Provider business mailing address

725 RESERVOIR AVE STE 103
CRANSTON RI
02910-4451
US

V. Phone/Fax

Practice location:
  • Phone: 401-829-4446
  • Fax: 401-829-4434
Mailing address:
  • Phone: 401-829-4446
  • Fax: 401-829-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN01452
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN01452
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: