Provider Demographics
NPI:1205845625
Name:SNIDER, JENNIFER L (CRNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SNIDER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:HERTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2411 E RIVERSIDE DR
Mailing Address - Street 2:APT F201
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7545
Mailing Address - Country:US
Mailing Address - Phone:509-481-8295
Mailing Address - Fax:208-523-8978
Practice Address - Street 1:2411 E RIVERSIDE DR
Practice Address - Street 2:APT F201
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616
Practice Address - Country:US
Practice Address - Phone:509-481-8295
Practice Address - Fax:208-523-8978
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007244367500000X
IDRNA-896A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1053714717Medicaid
WA8858489Medicare ID - Type Unspecified