Provider Demographics
NPI:1336394501
Name:SNYDER, MANDY L (ACNP)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:L
Last Name:SNYDER
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:L
Other - Last Name:CREVISTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5169 S COTTONWOOD ST STE 520
Mailing Address - Street 2:ECCLES OUTPATIENT CARE CENTER
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6767
Mailing Address - Country:US
Mailing Address - Phone:801-507-3500
Mailing Address - Fax:801-507-3505
Practice Address - Street 1:5169 S COTTONWOOD ST STE 520
Practice Address - Street 2:ECCLES OUTPATIENT CARE CENTER
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6767
Practice Address - Country:US
Practice Address - Phone:801-507-3500
Practice Address - Fax:801-507-3505
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5255600-4405363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care