Healthcare Provider Details

I. General information

NPI: 1346618360
Provider Name (Legal Business Name): SHAWN SNYDER DNP, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 BLACKMORE RD
CASPER WY
82609-3345
US

IV. Provider business mailing address

5000 BLACKMORE RD
CASPER WY
82609-3345
US

V. Phone/Fax

Practice location:
  • Phone: 307-233-6000
  • Fax:
Mailing address:
  • Phone: 307-233-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26210-1431
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: