Provider Demographics
NPI:1508210865
Name:SNOWDEN, VIVA LASHAWN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:VIVA
Middle Name:LASHAWN
Last Name:SNOWDEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 IRISH LN
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2438
Mailing Address - Country:US
Mailing Address - Phone:770-841-5477
Mailing Address - Fax:
Practice Address - Street 1:160 IRISH LN
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2438
Practice Address - Country:US
Practice Address - Phone:770-841-5477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF1215440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily