Provider Demographics
NPI:1790110419
Name:SNODGRASS, NIKKI DANAE (CRNA)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:DANAE
Last Name:SNODGRASS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 HEALTHCARE LOOP
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-7072
Mailing Address - Country:US
Mailing Address - Phone:980-302-1000
Mailing Address - Fax:980-302-1001
Practice Address - Street 1:8201 HEALTHCARE LOOP
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7072
Practice Address - Country:US
Practice Address - Phone:980-302-1000
Practice Address - Fax:980-302-1001
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90747367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered