Provider Demographics
NPI:1952814691
Name:SNODGRASS, KRISTA (LPN)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:SNODGRASS
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 779
Mailing Address - Street 2:
Mailing Address - City:WISNER
Mailing Address - State:NE
Mailing Address - Zip Code:68791-0779
Mailing Address - Country:US
Mailing Address - Phone:402-529-2233
Mailing Address - Fax:
Practice Address - Street 1:302 W PHILLIP AVE STE 100
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5248
Practice Address - Country:US
Practice Address - Phone:402-529-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23023164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse