Provider Demographics
NPI:1972885374
Name:SNEDIKER, MARY MORGAN (NP-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MORGAN
Last Name:SNEDIKER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 REMINGTON BLVD 100
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4707
Mailing Address - Country:US
Mailing Address - Phone:630-914-2468
Mailing Address - Fax:630-914-2469
Practice Address - Street 1:1625 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1824
Practice Address - Country:US
Practice Address - Phone:847-251-1500
Practice Address - Fax:847-251-2191
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008895363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health