Provider Demographics
NPI:1124356647
Name:SNODGRASS, DANIELLE W (RRA)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:W
Last Name:SNODGRASS
Suffix:
Gender:F
Credentials:RRA
Other - Prefix:
Other - First Name:DANNIE
Other - Middle Name:W
Other - Last Name:SNODGRASS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RRA
Mailing Address - Street 1:119 FISH OR CUT BAIT RD
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32433-4630
Mailing Address - Country:US
Mailing Address - Phone:706-298-9434
Mailing Address - Fax:
Practice Address - Street 1:119 FISH OR CUT BAIT RD
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433-4630
Practice Address - Country:US
Practice Address - Phone:706-298-9434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2510243U00000X
MTRTS-RT-LIC-25944243U00000X
3216112471C3402X
FLRA77243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography