Healthcare Provider Details

I. General information

NPI: 1902027089
Provider Name (Legal Business Name): ELIZABETH AGNES SNIDER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SUMMIT AVE
PROVIDENCE RI
02906
US

IV. Provider business mailing address

25 HOLBROOK LN
UXBRIDGE MA
01569
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-3902
  • Fax:
Mailing address:
  • Phone: 508-278-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNPP37194
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: