Provider Demographics
NPI:1902188261
Name:SNOW, BETINA C
Entity Type:Individual
Prefix:MISS
First Name:BETINA
Middle Name:C
Last Name:SNOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 COWBOYS PKWY
Mailing Address - Street 2:APARTMENT # 2070
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5930
Mailing Address - Country:US
Mailing Address - Phone:214-734-9646
Mailing Address - Fax:
Practice Address - Street 1:171 COWBOYS PKWY
Practice Address - Street 2:APARTMENT # 2070
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-5930
Practice Address - Country:US
Practice Address - Phone:214-734-9646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy