Provider Demographics
NPI:1245571413
Name:SNYDER, GRACE SL (NP)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:SL
Last Name:SNYDER
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:275 E COTTONWOOD LN
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-2556
Mailing Address - Country:US
Mailing Address - Phone:520-316-9690
Mailing Address - Fax:520-836-0256
Practice Address - Street 1:275 E COTTONWOOD LN
Practice Address - Street 2:SUITE 3
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2556
Practice Address - Country:US
Practice Address - Phone:520-316-9690
Practice Address - Fax:520-836-0256
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZRN048787363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ73648Medicare PIN