Provider Demographics
NPI:1982420519
Name:SNIDERMAN, COURTNEY (NP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:SNIDERMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37172 ONEILL DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2450
Mailing Address - Country:US
Mailing Address - Phone:440-785-1887
Mailing Address - Fax:
Practice Address - Street 1:940 DISC DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95066-4544
Practice Address - Country:US
Practice Address - Phone:831-431-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95072499163WH1000X
CA95015433363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WH1000XNursing Service ProvidersRegistered NurseHospice