Healthcare Provider Details

I. General information

NPI: 1033389929
Provider Name (Legal Business Name): KATHERINE A SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 DIAMOND VALLEY RD UNIT B
MARKLEEVILLE CA
96120-9512
US

IV. Provider business mailing address

75 DIAMOND VALLEY RD UNIT B
MARKLEEVILLE CA
96120-9512
US

V. Phone/Fax

Practice location:
  • Phone: 530-694-2146
  • Fax: 530-694-2770
Mailing address:
  • Phone: 530-694-2146
  • Fax: 530-694-2770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number230036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: