Healthcare Provider Details

I. General information

NPI: 1508243452
Provider Name (Legal Business Name): MARIE ELAINE SNYDER RN, ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 RIVER PARK DR STE 200
SACRAMENTO CA
95815-4530
US

IV. Provider business mailing address

6622 VERANDA CT N
KEIZER OR
97303-4226
US

V. Phone/Fax

Practice location:
  • Phone: 916-325-1040
  • Fax:
Mailing address:
  • Phone: 951-473-9139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number458695
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201340838RN
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number21489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: