Provider Demographics
NPI:1548645203
Name:SNIDER, ALYSE M (CNP)
Entity type:Individual
Prefix:
First Name:ALYSE
Middle Name:M
Last Name:SNIDER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:419-315-1225
Mailing Address - Fax:419-315-1226
Practice Address - Street 1:1180 N MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-4932
Practice Address - Country:US
Practice Address - Phone:419-315-1225
Practice Address - Fax:419-315-1226
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17611-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner