Provider Demographics
NPI:1689086415
Name:SNOW, JACQUELINE LYNCH (MN, CNP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:LYNCH
Last Name:SNOW
Suffix:
Gender:F
Credentials:MN, CNP
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:BRAUNSTEIN
Other - Last Name:LYNCH.(MNCNP)
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MN CNP
Mailing Address - Street 1:2121 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403
Mailing Address - Country:US
Mailing Address - Phone:310-264-1777
Mailing Address - Fax:310-264-1787
Practice Address - Street 1:2121 WILSHIRE BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403
Practice Address - Country:US
Practice Address - Phone:310-264-1777
Practice Address - Fax:310-264-1787
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235187RN363LW0102X
CAN.P.C#6845363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health