Healthcare Provider Details

I. General information

NPI: 1053384594
Provider Name (Legal Business Name): DANIEL SNYDER MSN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3845 BROADWAY BLVD
KANSAS CITY MO
64111-2507
US

IV. Provider business mailing address

3845 BROADWAY BLVD
KANSAS CITY MO
64111-2507
US

V. Phone/Fax

Practice location:
  • Phone: 816-561-1629
  • Fax:
Mailing address:
  • Phone: 816-561-1629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number130160
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: