Provider Demographics
NPI:1265789663
Name:SNOW, EMILY C (FNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:C
Last Name:SNOW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600B CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2124
Mailing Address - Country:US
Mailing Address - Phone:207-774-5222
Mailing Address - Fax:207-761-4433
Practice Address - Street 1:1600B CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2124
Practice Address - Country:US
Practice Address - Phone:207-774-5222
Practice Address - Fax:207-761-4433
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN58956163W00000X
MECNP121082363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse