Basic Information
| Provider Information | |||||||||
| NPI: | 1508243452 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNYDER | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Credential: | RN, ACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6622 VERANDA CT N | ||||||||
| Address2: | |||||||||
| City: | KEIZER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973034226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514739139 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1485 RIVER PARK DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958154530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163251040 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2015 | ||||||||
| LastUpdateDate: | 04/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 458695 | CA | N | Nursing Service Providers | Registered Nurse | 163W00000X | 201340838RN | OR | N | Nursing Service Providers | Registered Nurse | 363L00000X | 21489 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.