Healthcare Provider Details

I. General information

NPI: 1750421467
Provider Name (Legal Business Name): ANNETTE M SNYDER MS RD LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 S MAIN ST
CLARION IA
50525-2019
US

IV. Provider business mailing address

1316 S MAIN ST
CLARION IA
50525-2019
US

V. Phone/Fax

Practice location:
  • Phone: 515-532-9271
  • Fax: 515-532-3844
Mailing address:
  • Phone: 515-532-9271
  • Fax: 515-532-3844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number01652
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: