Provider Demographics
NPI:1760824973
Name:SNYDER, KATHY (LPN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name: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:PO BOX 5292
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-0292
Mailing Address - Country:US
Mailing Address - Phone:440-391-8202
Mailing Address - Fax:
Practice Address - Street 1:30204 GEBHART PL
Practice Address - Street 2:
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095-4915
Practice Address - Country:US
Practice Address - Phone:440-391-8202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH124842164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse