Provider Demographics
NPI:1164651725
Name:GIBSON-SNYDER, JENNIFER KATHRYN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KATHRYN
Last Name:GIBSON-SNYDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 34439
Mailing Address - Street 2:PROVIDENCE HEALTH AND SERVICES, MT
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98214-1439
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 W. BROADWAY
Practice Address - Street 2:PROVIDENCE SAINT PATRICK HOSPITAL
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4008
Practice Address - Country:US
Practice Address - Phone:206-680-1361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-04
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML60093524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine