Provider Demographics
NPI:1477535581
Name:SNOW, TIMOTHY MATTHEW (RNC, NNP, MSN)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MATTHEW
Last Name:SNOW
Suffix:
Gender:M
Credentials:RNC, NNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4999 NC HIGHWAY 268
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-8008
Mailing Address - Country:US
Mailing Address - Phone:336-374-6915
Mailing Address - Fax:336-713-6434
Practice Address - Street 1:MEDICAL CENTER BOULEVARD
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-713-6428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC930238363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC930238Medicare UPIN