Healthcare Provider Details

I. General information

NPI: 1457169161
Provider Name (Legal Business Name): JILLIAN SNYDER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ELLIOT WAY STE 200
MANCHESTER NH
03103-3553
US

IV. Provider business mailing address

4 ELLIOT WAY STE 200
MANCHESTER NH
03103-3544
US

V. Phone/Fax

Practice location:
  • Phone: 603-438-0413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number085597-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: