Provider Demographics
NPI:1952021412
Name:SNIDER, BLAIR ALIZABETH (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:BLAIR
Middle Name:ALIZABETH
Last Name:SNIDER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:BLAIR
Other - Middle Name:PECANTY
Other - Last Name:SNIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:2775 W TANK FARM RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-0219
Mailing Address - Country:US
Mailing Address - Phone:337-794-0455
Mailing Address - Fax:
Practice Address - Street 1:2775 W TANK FARM RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-0219
Practice Address - Country:US
Practice Address - Phone:337-794-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA227245363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily