Provider Demographics
NPI:1366691107
Name:SNOW, BRENDA GAIL (MED,RD,LD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:GAIL
Last Name:SNOW
Suffix:
Gender:F
Credentials:MED,RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 RIDGECREST RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-6004
Mailing Address - Country:US
Mailing Address - Phone:903-583-3985
Mailing Address - Fax:903-455-9914
Practice Address - Street 1:4309 RIDGECREST RD
Practice Address - Street 2:SUITE 150
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6004
Practice Address - Country:US
Practice Address - Phone:903-455-9922
Practice Address - Fax:903-455-9914
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04362133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered