Provider Demographics
NPI: | 1174500433 |
---|---|
Name: | SNOW, AMY E (CRNA) |
Entity Type: | Individual |
Prefix: | |
First Name: | AMY |
Middle Name: | E |
Last Name: | SNOW |
Suffix: | |
Gender: | F |
Credentials: | CRNA |
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 1123 |
Mailing Address - Street 2: | |
Mailing Address - City: | JACKSON |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 49204-1123 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-242-1131 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 810 SAINT VINCENTS DR |
Practice Address - Street 2: | |
Practice Address - City: | BIRMINGHAM |
Practice Address - State: | AL |
Practice Address - Zip Code: | 35205-1601 |
Practice Address - Country: | US |
Practice Address - Phone: | 205-939-7143 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-12-28 |
Last Update Date: | 2010-06-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AL | 1-074383 | 367500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AL | 051518081 | Medicaid | |
AL | 051533368 | Other | ARM BCBS |
AL | P00281005 | Other | ARM MEDICARE RAILROAD |
AL | 051518081 | Medicaid | |
AL | 051533368 | Other | ARM BCBS |
AL | P00281005 | Other | ARM MEDICARE RAILROAD |