Healthcare Provider Details

I. General information

NPI: 1477535581
Provider Name (Legal Business Name): TIMOTHY MATTHEW SNOW RNC, NNP, MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BOULEVARD
WINSTON-SALEM NC
27103
US

IV. Provider business mailing address

4999 NC HIGHWAY 268
DOBSON NC
27017-8008
US

V. Phone/Fax

Practice location:
  • Phone: 336-713-6428
  • Fax:
Mailing address:
  • Phone: 336-374-6915
  • Fax: 336-713-6434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number930238
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: