Healthcare Provider Details

I. General information

NPI: 1780092239
Provider Name (Legal Business Name): MRS. JENNIFER ELIZABETH SNIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 ALDEN CIR NE
FRIDLEY MN
55432-3024
US

IV. Provider business mailing address

81 ALDEN CIR NE
FRIDLEY MN
55432-3024
US

V. Phone/Fax

Practice location:
  • Phone: 612-210-7241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberR212363
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: