Provider Demographics
NPI:1033325535
Name:SNYDER, ANDREA DAWN (LMP)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:DAWN
Last Name:SNYDER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16831 52ND AVE W
Mailing Address - Street 2:#F15
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3050
Mailing Address - Country:US
Mailing Address - Phone:425-319-0608
Mailing Address - Fax:
Practice Address - Street 1:125 164TH ST SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-5947
Practice Address - Country:US
Practice Address - Phone:425-745-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016489174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0159648OtherL & I