Provider Demographics
NPI:1942560289
Name:SNELL, JUNE A (RN/LDN)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:A
Last Name:SNELL
Suffix:
Gender:F
Credentials:RN/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1753
Mailing Address - Country:US
Mailing Address - Phone:814-871-4531
Mailing Address - Fax:814-871-4617
Practice Address - Street 1:560 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1753
Practice Address - Country:US
Practice Address - Phone:814-871-4531
Practice Address - Fax:814-871-4617
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001491133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA236002830Medicaid