Healthcare Provider Details

I. General information

NPI: 1902093362
Provider Name (Legal Business Name): TERRI LEE SNYDER NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

705 WEST ST
SUSANVILLE CA
96130-4834
US

IV. Provider business mailing address

713-400 JETER RD
JANESVILLE CA
96114
US

V. Phone/Fax

Practice location:
  • Phone: 530-257-7251
  • Fax:
Mailing address:
  • Phone: 530-386-4487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number403278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: