Provider Demographics
NPI:1467428912
Name:VAN SNEPSON, SALLY (PA)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:VAN SNEPSON
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 1:8 E COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4382
Mailing Address - Country:US
Mailing Address - Phone:877-634-7333
Mailing Address - Fax:866-984-3891
Practice Address - Street 1:3633 CROSSINGS DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7101
Practice Address - Country:US
Practice Address - Phone:877-634-7333
Practice Address - Fax:866-984-3891
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC 287171100000X
MEPA-817363A00000X
AZ5181363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEQ01576Medicare UPIN
MEAP2027Medicare ID - Type Unspecified