Provider Demographics
NPI:1255486759
Name:SNOW, MARTHA M (MSN, PMHCNS-BC, CARN)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:M
Last Name:SNOW
Suffix:
Gender:F
Credentials:MSN, PMHCNS-BC, CARN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 MONTGOMERY BLVD NE STE V
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2470
Mailing Address - Country:US
Mailing Address - Phone:505-217-1717
Mailing Address - Fax:505-213-0041
Practice Address - Street 1:3939 SAN PEDRO DR NE BLDG D1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-8905
Practice Address - Country:US
Practice Address - Phone:505-217-1717
Practice Address - Fax:505-213-0041
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR24635163WP0809X, 364SP0809X
NMR 24635163WA0400X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM40483738Medicaid
NM40483738Medicaid