Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 12011913A | IN |
Y | 1223G0001X | General Practice | 019.028197 | IL |
Y | 213EG0000X | General Practice | 019.028197 | IL |
NPI | 1720308497 |
---|---|
Provider Name | Dr. Christine Marie Snow |
First Address | Homewood, IL 60430-2127 |
Second Address | Homewood, IL 60430-2127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2010 |
Last Update Date | 29/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201137880 | (05) | IN |