Healthcare Provider Details

I. General information

NPI: 1720413180
Provider Name (Legal Business Name): NICOLE SNYDER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2979 SQUALICUM PKWY #101
BELLINGHAM WA
98225
US

IV. Provider business mailing address

1115 SE 164TH AVE DEPT. 358
VANCOUVER WA
98683-9324
US

V. Phone/Fax

Practice location:
  • Phone: 360-734-2700
  • Fax:
Mailing address:
  • Phone: 360-510-9702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP 60406239
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP60406239
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: