Provider Demographics
NPI:1720056583
Name:SNOW, PAMELA M (PA-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:SNOW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:M
Other - Last Name:RIPKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:8208 LOUISIANA BLVD NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1757
Mailing Address - Country:US
Mailing Address - Phone:505-858-1222
Mailing Address - Fax:505-858-1224
Practice Address - Street 1:8208 LOUISIANA BLVD NE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1757
Practice Address - Country:US
Practice Address - Phone:505-858-1222
Practice Address - Fax:505-858-1224
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2004-0022208100000X, 363A00000X
MN9359363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000Z5352Medicaid
342701601Medicare PIN
MNP34063Medicare UPIN
NM000Z5352Medicaid