Healthcare Provider Details

I. General information

NPI: 1609067347
Provider Name (Legal Business Name): ANNA B SNYDER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 NORTH FREEDOM BLVD SUITE 15
PROVO UT
84604
US

IV. Provider business mailing address

1675 N FREEDOM BLVD STE 15
PROVO UT
84604-6909
US

V. Phone/Fax

Practice location:
  • Phone: 801-373-0167
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: