Provider Demographics
NPI:1871670422
Name:SNOW, MARY JUNE
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JUNE
Last Name:SNOW
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:JUNE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5364 N PUMA RD
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-8663
Mailing Address - Country:US
Mailing Address - Phone:520-248-0912
Mailing Address - Fax:
Practice Address - Street 1:5364 N PUMA RD
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-8663
Practice Address - Country:US
Practice Address - Phone:520-248-0912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4123385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ646028Medicaid