Provider Demographics
NPI:1326449240
Name:SNYDER, SUSIE I (LPN)
Entity Type:Individual
Prefix:
First Name:SUSIE
Middle Name:
Last Name:SNYDER
Suffix:I
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:978 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-9725
Mailing Address - Country:US
Mailing Address - Phone:440-593-3704
Mailing Address - Fax:
Practice Address - Street 1:978 CENTER RD
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-9725
Practice Address - Country:US
Practice Address - Phone:440-593-3704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN094594164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse