Provider Demographics
NPI:1477146207
Name:SNIATKEWICZ, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:SNIATKEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 SPRING HILL FARM DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-8407
Mailing Address - Country:US
Mailing Address - Phone:314-497-5281
Mailing Address - Fax:
Practice Address - Street 1:858 SPRING HILL FARM DR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-8407
Practice Address - Country:US
Practice Address - Phone:314-497-5281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021002286363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health