Provider Demographics
NPI:1376753590
Name:SNIDER, SYLVIA ROSE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:ROSE
Last Name:SNIDER
Suffix:
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 1:40 HORSETHIEF CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROUNDUP
Mailing Address - State:MT
Mailing Address - Zip Code:59072-6325
Mailing Address - Country:US
Mailing Address - Phone:406-323-3212
Mailing Address - Fax:406-323-3209
Practice Address - Street 1:40 HORSETHIEF CREEK RD
Practice Address - Street 2:
Practice Address - City:ROUNDUP
Practice Address - State:MT
Practice Address - Zip Code:59072-6325
Practice Address - Country:US
Practice Address - Phone:406-323-3212
Practice Address - Fax:406-323-3209
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11178310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000700417Medicaid