Provider Demographics
NPI:1851175186
Name:SNOW, KEALOHA SARAH REIKO
Entity Type:Individual
Prefix:
First Name:KEALOHA
Middle Name:SARAH REIKO
Last Name:SNOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KEALOHA
Other - Middle Name:SARAH REIKO
Other - Last Name:KAGAWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1485 W 1930 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-9403
Mailing Address - Country:US
Mailing Address - Phone:808-561-3254
Mailing Address - Fax:
Practice Address - Street 1:720 N 530 E
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-4104
Practice Address - Country:US
Practice Address - Phone:385-498-7506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2064952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5916938-8900OtherAPRN CONTROLLED SUBSTANCE
UT5916938-4405OtherAPRN