Provider Demographics
NPI:1528602166
Name:SNYDER, REBECCA ANNE
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:SNYDER
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 1:510 GREENWOOD PL
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2526
Mailing Address - Country:US
Mailing Address - Phone:315-289-0878
Mailing Address - Fax:
Practice Address - Street 1:510 GREENWOOD PL
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2526
Practice Address - Country:US
Practice Address - Phone:315-289-0878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323484164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse