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NPI Code Detail

MEDICARE: REBECCA R SNIDER-FULLER PCNS

MEDICARE: REBECCA R SNIDER-FULLER PCNS
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
1364S00000XClinical Nurse SpecialistNS02942OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336164714
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA R SNIDER-FULLER PCNS
Provider Business Mailing Address
First Line : 6835 BROADWAY AVE
Second Line : METROHEALTH BROADWAY HEALTH CENTER
City : CLEVELAND
State : OH
Zip : 44105-1313
Country : US
Telephone Number : 216-957-1807
Fax Number :
Provider Business Practice Location Address
First Line : 6835 BROADWAY AVE
Second Line : METROHEALTH BROADWAY HEALTH CENTER
City : CLEVELAND
State : OH
Zip : 44105-1313
Country : US
Telephone Number : 216-957-1807
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2006
Last Update Date : 07/08/2007

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