Provider Demographics
NPI:1568239077
Name:SNELL, HYRUM
Entity Type:Individual
Prefix:
First Name:HYRUM
Middle Name:
Last Name:SNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S KAYS DR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-4208
Mailing Address - Country:US
Mailing Address - Phone:801-200-9612
Mailing Address - Fax:
Practice Address - Street 1:5217 S STATE ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4813
Practice Address - Country:US
Practice Address - Phone:801-313-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant