Provider Demographics
NPI:1144755810
Name:SNIDER, TINA LYNN (RN IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:LYNN
Last Name:SNIDER
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72904-2414
Mailing Address - Country:US
Mailing Address - Phone:479-651-6893
Mailing Address - Fax:
Practice Address - Street 1:4320 N 32ND ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72904-2414
Practice Address - Country:US
Practice Address - Phone:479-651-6893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR094542163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant