Provider Demographics
NPI:1457668345
Name:SNACKI, DIANE JEANNE (RN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:JEANNE
Last Name:SNACKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-3210
Mailing Address - Country:US
Mailing Address - Phone:216-314-4179
Mailing Address - Fax:
Practice Address - Street 1:5112 CHESTNUT RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-3210
Practice Address - Country:US
Practice Address - Phone:216-314-4179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 363665163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse