Provider Demographics
NPI:1437592185
Name:SNYDER, TABITHA JUNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:JUNE
Last Name:SNYDER
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 1:367 N STAR ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-1160
Mailing Address - Country:US
Mailing Address - Phone:740-418-4657
Mailing Address - Fax:
Practice Address - Street 1:367 N STAR ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1160
Practice Address - Country:US
Practice Address - Phone:740-418-4657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH138161164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse