Healthcare Provider Details

I. General information

NPI: 1194856542
Provider Name (Legal Business Name): SUSAN JANE SNYDER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4116 UNIVERSITY AVE
DES MOINES IA
50311-3533
US

IV. Provider business mailing address

4116 UNIVERSITY AVE
DES MOINES IA
50311-3533
US

V. Phone/Fax

Practice location:
  • Phone: 515-274-1518
  • Fax: 515-274-6916
Mailing address:
  • Phone: 515-274-1518
  • Fax: 515-274-6916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4286A
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3882
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: