Provider Demographics
NPI:1770805301
Name:SNOW, ANNETTE MARIA (RD)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MARIA
Last Name:SNOW
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 LACEY RD
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3021
Mailing Address - Country:US
Mailing Address - Phone:203-988-0931
Mailing Address - Fax:
Practice Address - Street 1:54 LACEY RD
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:CT
Practice Address - Zip Code:06524-3021
Practice Address - Country:US
Practice Address - Phone:203-988-0931
Practice Address - Fax:203-393-3450
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000906133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered