Healthcare Provider Details

I. General information

NPI: 1992312151
Provider Name (Legal Business Name): VICKY SNOWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 S MAIN ST
SAINT CHARLES MO
63303-4149
US

IV. Provider business mailing address

1601 OLD SOUTH RIVER RD
SAINT CHARLES MO
63303-4120
US

V. Phone/Fax

Practice location:
  • Phone: 636-224-1000
  • Fax: 636-669-1010
Mailing address:
  • Phone: 636-224-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2017024697
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: