Basic Information
| Provider Information | |||||||||
| NPI: | 1700433562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNIDER | ||||||||
| FirstName: | REBECKA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1027 EVERGREEN ST | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997094306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074518164 | ||||||||
| FaxNumber: | 9074510273 | ||||||||
| Practice Location | |||||||||
| Address1: | 1027 EVERGREEN ST | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997094306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074518164 | ||||||||
| FaxNumber: | 9074510273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2019 | ||||||||
| LastUpdateDate: | 08/26/2019 | ||||||||
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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 | 163W00000X | 147280 | AK | Y | Nursing Service Providers | Registered Nurse |
No ID Information.