Provider Demographics
NPI:1245619733
Name:SNOW, ANNETTE (LPN)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:SNOW
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2729
Mailing Address - Country:US
Mailing Address - Phone:315-271-7871
Mailing Address - Fax:
Practice Address - Street 1:1603 N MADISON ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2729
Practice Address - Country:US
Practice Address - Phone:315-271-7871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10-275910164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse