Provider Demographics
NPI:1508464694
Name:SNELL, PHEBEAN
Entity Type:Individual
Prefix:
First Name:PHEBEAN
Middle Name:
Last Name:SNELL
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 1:4444 68TH PL APT A3
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2033
Mailing Address - Country:US
Mailing Address - Phone:707-334-5202
Mailing Address - Fax:
Practice Address - Street 1:4444 68TH PL APT A3
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-2033
Practice Address - Country:US
Practice Address - Phone:707-334-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCNA20201768Medicaid