Provider Demographics
NPI:1508243452
Name:SNYDER, MARIE ELAINE (RN, ACNP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELAINE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:RN, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6622 VERANDA CT N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4226
Mailing Address - Country:US
Mailing Address - Phone:951-473-9139
Mailing Address - Fax:
Practice Address - Street 1:1485 RIVER PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4530
Practice Address - Country:US
Practice Address - Phone:916-325-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458695163W00000X
OR201340838RN163W00000X
CA21489363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse