Basic Information
Provider Information
NPI: 1568986727
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SNELL
FirstName: REBECCA
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7491 SHERWOOD CROSSING PL APT 202
Address2:  
City: MECHANICSVILLE
State: VA
PostalCode: 231113639
CountryCode: US
TelephoneNumber: 8047613981
FaxNumber:  
Practice Location
Address1: 1300 E MARSHALL ST
Address2:  
City: RICHMOND
State: VA
PostalCode: 232985054
CountryCode: US
TelephoneNumber: 8048283144
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/31/2017
LastUpdateDate: 07/31/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X0024174874VAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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