Healthcare Provider Details

I. General information

NPI: 1548851959
Provider Name (Legal Business Name): MICHAEL SNYDER FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 02/10/2025
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 E BANNER GATEWAY DRIVE SUITE 450
GILBERT AZ
85234-2165
US

IV. Provider business mailing address

2940 E BANNER GATEWAY DRIVE SUITE 450
GILBERT AZ
85234-2165
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-6444
  • Fax: 480-256-4734
Mailing address:
  • Phone: 480-256-6444
  • Fax: 480-256-4734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number249716
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: