Healthcare Provider Details

I. General information

NPI: 1811127244
Provider Name (Legal Business Name): CELESTE SNIDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SUMMERWOOD DRIVE NW
ALBUQUERQUE NM
87120
US

IV. Provider business mailing address

2000 SUMMERWOOD DRIVE NW
ALBUQUERQUE NM
87120
US

V. Phone/Fax

Practice location:
  • Phone: 505-839-4745
  • Fax:
Mailing address:
  • Phone: 505-839-4745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR31926
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: