Healthcare Provider Details

I. General information

NPI: 1306426739
Provider Name (Legal Business Name): LINDSEY NICOLE SNIDER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 W AGUA FRIA FWY STE 1
PHOENIX AZ
85027-3967
US

IV. Provider business mailing address

4122 W ORAIBI DR
GLENDALE AZ
85308-7423
US

V. Phone/Fax

Practice location:
  • Phone: 623-777-3271
  • Fax:
Mailing address:
  • Phone: 530-949-9639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number255266
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: