Healthcare Provider Details

I. General information

NPI: 1699008342
Provider Name (Legal Business Name): HEATHER SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3365 MITCHELL STREET
LORIS SC
29569-9601
US

IV. Provider business mailing address

3365 MITCHELL STREET
LORIS SC
29569-9601
US

V. Phone/Fax

Practice location:
  • Phone: 843-716-7596
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3991
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: