Healthcare Provider Details

I. General information

NPI: 1366185803
Provider Name (Legal Business Name): SAMANTHA SUZANNE SNYDER BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4521 THOMAS JEFFERSON ST
CALDWELL ID
83605-5100
US

IV. Provider business mailing address

4521 THOMAS JEFFERSON ST
CALDWELL ID
83605-5100
US

V. Phone/Fax

Practice location:
  • Phone: 208-454-4820
  • Fax: 208-454-4859
Mailing address:
  • Phone: 208-454-4820
  • Fax: 208-454-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number58591
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: