Healthcare Provider Details

I. General information

NPI: 1922486463
Provider Name (Legal Business Name): JUANITA SNYDER-NELSON LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2015
Last Update Date: 05/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 BELAIR PL
MOSES LAKE WA
98837-2512
US

IV. Provider business mailing address

2039 BELAIR PL
MOSES LAKE WA
98837-2512
US

V. Phone/Fax

Practice location:
  • Phone: 509-989-8183
  • Fax:
Mailing address:
  • Phone: 509-989-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA 60524237
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: