Provider Demographics
NPI:1124113394
Name:SNIDER, SUSANNE MILLS (CRNP)
Entity type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:MILLS
Last Name:SNIDER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12792 SHELLY HUGHES RD
Mailing Address - Street 2:
Mailing Address - City:BUHL
Mailing Address - State:AL
Mailing Address - Zip Code:35446-9164
Mailing Address - Country:US
Mailing Address - Phone:205-339-7165
Mailing Address - Fax:205-373-2544
Practice Address - Street 1:2810 LURLEEN WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3249
Practice Address - Country:US
Practice Address - Phone:205-373-6323
Practice Address - Fax:205-373-2544
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-068376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL104831Medicaid
AL510I500266Medicare PIN