Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 2019024744 | MO |
N | 363L00000X | Nurse Practitioner | 209019574 | IL |
NPI | 1003478066 |
---|---|
Provider Name | Cynthia Snider |
First Address | Festus, MO 63028-2611 |
Second Address | Festus, MO 63028-2611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2019 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2019024744 | MO STATE LICENSE (01) | MO |