Provider Demographics
NPI:1437205150
Name:SNOW, WHITNEY L (PA)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:L
Last Name:SNOW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6071 E WOODMEN RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2613
Mailing Address - Country:US
Mailing Address - Phone:719-531-7007
Mailing Address - Fax:719-531-7122
Practice Address - Street 1:6071 E WOODMEN RD STE 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2613
Practice Address - Country:US
Practice Address - Phone:719-531-7007
Practice Address - Fax:719-531-7122
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003028166363A00000X
COPA.0002452363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1437205150Medicaid
CO1437205150Medicaid
MO000097279Medicare ID - Type Unspecified
COC810544Medicare PIN