1649394743 NPI number — MRS. GRETTA SNYDER FORS BSN, MSN, RN, NP-C

Table of content: DR. ANNE CINDY LEE OD, FAAO (NPI 1366440018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649394743 NPI number — MRS. GRETTA SNYDER FORS BSN, MSN, RN, NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORS
Provider First Name:
GRETTA
Provider Middle Name:
SNYDER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BSN, MSN, RN, NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SNYDER
Provider Other First Name:
GRETCHEN
Provider Other Middle Name:
HUFF
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1649394743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
974 E 620 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVO
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84606-2004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-628-5037
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1750 NORTH WYMOUNT TERRACE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVO
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84602-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-422-2771
Provider Business Practice Location Address Fax Number:
801-422-0764
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  NP 15425 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 360925-8900 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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