MEDICARE: MRS. HEIDI ILENE SNYDER CHN, MS, NC, NE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133NN1002X	Nutrition Education Nutritionist		CA

General Provider Information

NPI Number	:	1881976538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEIDI ILENE SNYDER CHN, MS, NC, NE

Provider Business Mailing Address
First Line	:	1619 LINCOLN ST
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-8038
Country	:	US
Telephone Number	:	360-385-0999
Fax Number	:

Provider Business Practice Location Address
First Line	:	1619 LINCOLN ST
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-8038
Country	:	US
Telephone Number	:	360-385-0999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2011
Last Update Date	:	09/19/2011

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