Provider Demographics
NPI:1740959576
Name:SNYDER, EVAN TIMOTHY
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:TIMOTHY
Last Name:SNYDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 N LOVVORN RD
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANA
Mailing Address - State:TN
Mailing Address - Zip Code:37037-5316
Mailing Address - Country:US
Mailing Address - Phone:239-961-1293
Mailing Address - Fax:
Practice Address - Street 1:1516 N LOVVORN RD
Practice Address - Street 2:
Practice Address - City:CHRISTIANA
Practice Address - State:TN
Practice Address - Zip Code:37037-5316
Practice Address - Country:US
Practice Address - Phone:239-961-1293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program