Provider Demographics
NPI:1265701676
Name:SNB, LLC DBA PERSONAL HEALTH PARTNERS
Entity type:Organization
Organization Name:SNB, LLC DBA PERSONAL HEALTH PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERTONE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CLNC
Authorized Official - Phone:918-519-2919
Mailing Address - Street 1:2000 E 15TH ST
Mailing Address - Street 2:SUITE 300B
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6617
Mailing Address - Country:US
Mailing Address - Phone:405-330-5755
Mailing Address - Fax:405-330-5796
Practice Address - Street 1:2000 E 15TH ST
Practice Address - Street 2:SUITE 300B
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6697
Practice Address - Country:US
Practice Address - Phone:405-330-5755
Practice Address - Fax:405-330-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCLIA 37D0921553291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory