Provider Demographics
NPI:1437434552
Name:SNELL, CHARLES DAMON (RN BSN)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAMON
Last Name:SNELL
Suffix:
Gender:M
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4363 COACH LIGHT TRL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-8042
Mailing Address - Country:US
Mailing Address - Phone:937-750-0991
Mailing Address - Fax:
Practice Address - Street 1:4363 COACH LIGHT TRL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-8042
Practice Address - Country:US
Practice Address - Phone:937-750-0991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH283175163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical