Provider Demographics
NPI:1114982980
Name:SNOW, CLARE DIXON (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:CLARE
Middle Name:DIXON
Last Name:SNOW
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 105109
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-5109
Mailing Address - Country:US
Mailing Address - Phone:760-380-2553
Mailing Address - Fax:760-380-2122
Practice Address - Street 1:166 FOURTH STREET AND INNER LOOP RD
Practice Address - Street 2:ROOM 412
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-5109
Practice Address - Country:US
Practice Address - Phone:760-380-2553
Practice Address - Fax:760-380-2122
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY482297163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator