Provider Demographics
NPI:1346756574
Name:SNODGRASS, LEAH KAY (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:KAY
Last Name:SNODGRASS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98586-0026
Mailing Address - Country:US
Mailing Address - Phone:360-875-9343
Mailing Address - Fax:360-875-9323
Practice Address - Street 1:1530 BERRY ST
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:WA
Practice Address - Zip Code:98577-3924
Practice Address - Country:US
Practice Address - Phone:360-942-8784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00110950163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA196469Medicaid