Provider Demographics
NPI:1902996168
Name:SNYDER, MARSHA DANIELS (PHD,APRN,BC)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:DANIELS
Last Name:SNYDER
Suffix:
Gender:F
Credentials:PHD,APRN,BC
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Other - Credentials:
Mailing Address - Street 1:UIC COLLEGE OF NURSING (MC802) 845 S. DAMEN AVE.
Mailing Address - Street 2:PMA DEPARTMENT, SUITE 1022
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7350
Mailing Address - Country:US
Mailing Address - Phone:312-996-8011
Mailing Address - Fax:312-996-7725
Practice Address - Street 1:MILE SQUARE HEALTH CENTER , 2045 W. WASHINGTON BLVD.
Practice Address - Street 2:IHC, 2ND FLOOR, FAMILY MEDICINE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-355-3504
Practice Address - Fax:312-413-3664
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209001707364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0040030715OtherBC/BS
IL0040030715OtherBC/BS
IL211070Medicare ID - Type Unspecified