Provider Demographics
NPI:1912427030
Name:SNYDER, GWYNDOLYN SUZANNE (AGPCNP)
Entity Type:Individual
Prefix:
First Name:GWYNDOLYN
Middle Name:SUZANNE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082
Mailing Address - Country:US
Mailing Address - Phone:1719-680-1148
Mailing Address - Fax:
Practice Address - Street 1:1112 GRANT AVE
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082
Practice Address - Country:US
Practice Address - Phone:171-968-0114
Practice Address - Fax:719-680-1148
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992971-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health