Basic Information
| Provider Information | |||||||||
| NPI: | 1366583692 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNYDER | ||||||||
| FirstName: | JODI | ||||||||
| MiddleName: | |||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1260 MONROE ST NW STE 1A | ||||||||
| Address2: | |||||||||
| City: | NEW PHILADELPHIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446634147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306025339 | ||||||||
| FaxNumber: | 3306024200 | ||||||||
| Practice Location | |||||||||
| Address1: | 1260 MONROE ST NW STE 1A | ||||||||
| Address2: | |||||||||
| City: | NEW PHILADELPHIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446634147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306025339 | ||||||||
| FaxNumber: | 3306024200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 10/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | NP-08636 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 2005010276-22 | 01 | OH | BOARD CERTIFICATION NP | OTHER | NP-08636 | 01 | OH | OHIO BOARD OF NURSING | OTHER |