Provider Demographics
NPI:1861956583
Name:SNYDER, MARISSA (NP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:SNYDER
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 1:11960 LIONESS WAY
Mailing Address - Street 2:STE 230
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5644
Mailing Address - Country:US
Mailing Address - Phone:303-344-9090
Mailing Address - Fax:303-344-1922
Practice Address - Street 1:10101 RIDGEGATE PKWY
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5522
Practice Address - Country:US
Practice Address - Phone:330-225-6125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-27
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994414-NP363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology