Provider Demographics
NPI:1629833512
Name:SNOWDEN, BREANNA N
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:N
Last Name:SNOWDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:N
Other - Last Name:SNOWDEN WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:181 BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-2009
Mailing Address - Country:US
Mailing Address - Phone:585-683-3923
Mailing Address - Fax:
Practice Address - Street 1:181 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-2009
Practice Address - Country:US
Practice Address - Phone:585-683-3923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347115164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse