Provider Demographics
NPI:1376713594
Name:SNYDER, BECCA NICOLE (ARNP)
Entity Type:Individual
Prefix:
First Name:BECCA
Middle Name:NICOLE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:BECCA
Other - Middle Name:NICOLE
Other - Last Name:SILLIFANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0012
Mailing Address - Country:US
Mailing Address - Phone:406-327-1950
Mailing Address - Fax:
Practice Address - Street 1:601 W SPRUCE ST STE K
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4047
Practice Address - Country:US
Practice Address - Phone:406-327-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30008012363LA2200X
MTNUR-APRN-LIC-161090363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1376713594Medicaid