Provider Demographics
NPI:1073097879
Name:SNOW, ALICIA (NP-C)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:SNOW
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BIG ROCK RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04849-3467
Mailing Address - Country:US
Mailing Address - Phone:207-659-1281
Mailing Address - Fax:
Practice Address - Street 1:16 FAHY ST
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6029
Practice Address - Country:US
Practice Address - Phone:207-338-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP181228207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine