Provider Demographics
NPI:1407978638
Name:SNYDER, AUDREY (NP)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:SNYDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4248
Mailing Address - Country:US
Mailing Address - Phone:970-663-3500
Mailing Address - Fax:970-292-0898
Practice Address - Street 1:1200 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1004
Practice Address - Country:US
Practice Address - Phone:336-832-2840
Practice Address - Fax:336-832-3531
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991486-NP363LA2100X
NC101219363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA500018175OtherRAILROAD MEDICARE
VAP35740Medicare UPIN
VA500018175OtherRAILROAD MEDICARE