Healthcare Provider Details

I. General information

NPI: 1922821362
Provider Name (Legal Business Name): MIRANDA SNYDER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIRANDA MCDONALD

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21980 N 83RD AVE
PEORIA AZ
85383-1850
US

IV. Provider business mailing address

7048 W BAJADA RD
PEORIA AZ
85383-5096
US

V. Phone/Fax

Practice location:
  • Phone: 623-465-6375
  • Fax:
Mailing address:
  • Phone: 602-486-8266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number218070
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: