Provider Demographics
NPI:1366595886
Name:SNYDER, COLLEEN MARY (FNP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARY
Last Name:SNYDER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:RUSTEE
Other - Middle Name:
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:17095 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-6004
Mailing Address - Country:US
Mailing Address - Phone:760-241-6666
Mailing Address - Fax:760-247-4368
Practice Address - Street 1:19333 BEAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308
Practice Address - Country:US
Practice Address - Phone:760-241-6666
Practice Address - Fax:760-247-4368
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3670363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics