Provider Demographics
NPI:1578629903
Name:SNYDER, MARCIA DIANNE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:DIANNE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 W LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62681-1325
Mailing Address - Country:US
Mailing Address - Phone:217-322-6767
Mailing Address - Fax:
Practice Address - Street 1:238 S CONGRESS ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62681-1465
Practice Address - Country:US
Practice Address - Phone:217-322-4321
Practice Address - Fax:217-322-6459
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0209002403207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL88289Medicare ID - Type Unspecified
ILP40800Medicare UPIN