Healthcare Provider Details

I. General information

NPI: 1699385179
Provider Name (Legal Business Name): KENDRA SNELL BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2020
Last Update Date: 08/09/2020
Certification Date: 08/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 AUDUBON CIR
CHESAPEAKE VA
23320-0663
US

IV. Provider business mailing address

904 AUDUBON CIR
CHESAPEAKE VA
23320-0663
US

V. Phone/Fax

Practice location:
  • Phone: 757-803-7277
  • Fax:
Mailing address:
  • Phone: 757-803-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number000-1202878
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: