Healthcare Provider Details

I. General information

NPI: 1396954400
Provider Name (Legal Business Name): BETH ELAINE SNOOK NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS BETH ELAINE ALLEN

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4190 E WOODMEN RD SUITE 100
COLORADO SPRINGS CO
80920-8075
US

IV. Provider business mailing address

6521 DONAHUE DR
COLORADO SPRINGS CO
80923-7641
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-4455
  • Fax:
Mailing address:
  • Phone: 563-940-2344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.358885
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number1618400
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0991655
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: