Healthcare Provider Details

I. General information

NPI: 1235539677
Provider Name (Legal Business Name): MARY KATHERINE SNELL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 E WILCOX AVE
WHITE CLOUD MI
49349-8794
US

IV. Provider business mailing address

1035 E WILCOX AVE
WHITE CLOUD MI
49349-8794
US

V. Phone/Fax

Practice location:
  • Phone: 231-689-5943
  • Fax: 231-689-1275
Mailing address:
  • Phone: 231-689-5943
  • Fax: 231-689-1590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704230828
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: