Basic Information
| Provider Information | |||||||||
| NPI: | 1104574037 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SNODGRASS | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1103 E GRACE ST | ||||||||
| Address2: | |||||||||
| City: | RENSSELAER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479783210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198664135 | ||||||||
| FaxNumber: | 2198660803 | ||||||||
| Practice Location | |||||||||
| Address1: | 1103 E GRACE ST | ||||||||
| Address2: | |||||||||
| City: | RENSSELAER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479783210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198664135 | ||||||||
| FaxNumber: | 2198660803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2022 | ||||||||
| LastUpdateDate: | 03/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 71012354A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | F09210281 | 01 | IN | FNP CERTIFICATION | OTHER |