Healthcare Provider Details

I. General information

NPI: 1245571413
Provider Name (Legal Business Name): GRACE SL SNYDER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 E COTTONWOOD LN SUITE 3
CASA GRANDE AZ
85122-2556
US

IV. Provider business mailing address

275 E COTTONWOOD LN SUITE 3
CASA GRANDE AZ
85122-2556
US

V. Phone/Fax

Practice location:
  • Phone: 520-316-9690
  • Fax: 520-836-0256
Mailing address:
  • Phone: 520-316-9690
  • Fax: 520-836-0256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN048787
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: