Provider Demographics
NPI:1154191898
Name:SNIDER, SASCHA YVETTE (LPN)
Entity type:Individual
Prefix:
First Name:SASCHA
Middle Name:YVETTE
Last Name:SNIDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5504 WOODHALL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-2135
Mailing Address - Country:US
Mailing Address - Phone:313-402-3678
Mailing Address - Fax:
Practice Address - Street 1:5504 WOODHALL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-2135
Practice Address - Country:US
Practice Address - Phone:313-402-3678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703126033164W00000X
MI4704419168163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty