Healthcare Provider Details

I. General information

NPI: 1326603002
Provider Name (Legal Business Name): STEPHANIE FRANCIS SNYDER NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE OESCH

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S CEDAR ST STE 101
TACOMA WA
98405-2302
US

IV. Provider business mailing address

PO BOX 5299 MS: 820-5-PCO
TACOMA WA
98415-0299
US

V. Phone/Fax

Practice location:
  • Phone: 253-301-5370
  • Fax: 253-301-5379
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-78692-092
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP60964721
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: