Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 110022 | NE |
NPI | 1023004371 |
---|---|
Provider Name | Mary Monica Snow |
First Address | Lincoln, NE 68510-2229 |
Second Address | Lincoln, NE 68510-2229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 29/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47055126013 | (05) | NE |
P86712 | (02) |