Healthcare Provider Details

I. General information

NPI: 1366595886
Provider Name (Legal Business Name): COLLEEN MARY SNYDER F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUSTEE SNYDER F.N.P.

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19333 BEAR VALLEY RD
APPLE VALLEY CA
92308
US

IV. Provider business mailing address

17095 MAIN ST
HESPERIA CA
92345-6004
US

V. Phone/Fax

Practice location:
  • Phone: 760-241-6666
  • Fax: 760-247-4368
Mailing address:
  • Phone: 760-241-6666
  • Fax: 760-247-4368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: