Provider Demographics
NPI:1780753129
Name:SNELSON, JENNIFER VICTORIA (CRNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:VICTORIA
Last Name:SNELSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33505 27TH AVE E
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:WA
Mailing Address - Zip Code:98580-8877
Mailing Address - Country:US
Mailing Address - Phone:210-216-0464
Mailing Address - Fax:
Practice Address - Street 1:406 BLACK HILLS LN SW STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8144
Practice Address - Country:US
Practice Address - Phone:360-754-0287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO118970163W00000X
WARN60799759163W00000X
TX694263163W00000X
TXAP116073367500000X
WAAP60799760367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse