Provider Demographics
NPI:1306978820
Name:SNYDER, RICHARD D (CRNA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:SNYDER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 APACHE LN
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4336
Mailing Address - Country:US
Mailing Address - Phone:801-374-3155
Mailing Address - Fax:
Practice Address - Street 1:3021 APACHE LN
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4336
Practice Address - Country:US
Practice Address - Phone:801-374-3155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1068708163W00000X
UT192147-4406367500000X
KY1588A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered