Provider Demographics
NPI:1104396324
Name:SNOW FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:SNOW FAMILY MEDICINE, LLC
Other - Org Name:SNOW FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-BC, NP-C
Authorized Official - Phone:401-585-8500
Mailing Address - Street 1:23 ARROWHEAD TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-2846
Mailing Address - Country:US
Mailing Address - Phone:401-585-8500
Mailing Address - Fax:401-942-2200
Practice Address - Street 1:2220 PLAINFIELD PIKE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02921-2031
Practice Address - Country:US
Practice Address - Phone:401-585-8500
Practice Address - Fax:401-942-2200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1568827517Medicaid
RI1104396324Medicaid