Healthcare Provider Details

I. General information

NPI: 1700531308
Provider Name (Legal Business Name): ELEANOR C SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 BROZZINI CT
GREENVILLE SC
29615-5340
US

IV. Provider business mailing address

5 CRYSTAL SPRINGS RD APT 512
GREENVILLE SC
29615-3157
US

V. Phone/Fax

Practice location:
  • Phone: 864-288-7636
  • Fax:
Mailing address:
  • Phone: 518-354-0549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number53628
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: