Individual
JUSTIN RICHARD SNEDAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
801 W MAPLE ST, FARMINGTON, NM 87401-5630
(505) 609-2000
Mailing address
PO BOX 6210, FARMINGTON, NM 87499-6210
(505) 326-6400
(505) 326-4606
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN589897
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992028088
—
UT
05
—
40929051
—
NM
05
—
634505
—
AZ
05
—
67406203
—
CO
01
—
NMAAA1458
MEDICARE PTAN
NM
Enumeration date
03/04/2010
Last updated
07/26/2016
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