MEDICARE: LISA SNYDER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	300470	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	RN300470	OTHER	OH	REGISTER NURSE

General Provider Information

NPI Number	:	1295835973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA SNYDER RN

Provider Business Mailing Address
First Line	:	6971 COUNTY ROAD 121
Second Line	:
City	:	MOUNT GILEAD
State	:	OH
Zip	:	43338-9554
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6971 COUNTY ROAD 121
Second Line	:
City	:	MOUNT GILEAD
State	:	OH
Zip	:	43338-9554
Country	:	US
Telephone Number	:	614-622-9116
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2006
Last Update Date	:	07/09/2007

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