Provider Demographics
NPI:1881976538
Name:SNYDER, HEIDI ILENE (CHN, MS, NC, NE)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:ILENE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:CHN, MS, NC, NE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-8038
Mailing Address - Country:US
Mailing Address - Phone:360-385-0999
Mailing Address - Fax:
Practice Address - Street 1:1619 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-8038
Practice Address - Country:US
Practice Address - Phone:360-385-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education