Provider Demographics
NPI:1649396094
Name:BECKETT SNYDER, KAREN SUE (LPN)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUE
Last Name:BECKETT SNYDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 HERON ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-8742
Mailing Address - Country:US
Mailing Address - Phone:937-323-7111
Mailing Address - Fax:937-323-7111
Practice Address - Street 1:4621 HERON ROAD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-8742
Practice Address - Country:US
Practice Address - Phone:937-323-7111
Practice Address - Fax:937-323-7111
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN113093164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2444108Medicaid