Provider Demographics
NPI:1336773803
Name:SNELL, RANDI KAE (NP)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:KAE
Last Name:SNELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 E CHANDLER HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3302
Mailing Address - Country:US
Mailing Address - Phone:480-895-8369
Mailing Address - Fax:
Practice Address - Street 1:2995 E CHANDLER HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-3302
Practice Address - Country:US
Practice Address - Phone:480-895-8369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ246765363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily