Healthcare Provider Details

I. General information

NPI: 1255486759
Provider Name (Legal Business Name): MARTHA M. SNOW MSN, PMHCNS-BC, CARN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 SAN PEDRO DR NE BLDG D1
ALBUQUERQUE NM
87110-8905
US

IV. Provider business mailing address

9201 MONTGOMERY BLVD NE STE V
ALBUQUERQUE NM
87111-2470
US

V. Phone/Fax

Practice location:
  • Phone: 505-217-1717
  • Fax: 505-213-0041
Mailing address:
  • Phone: 505-217-1717
  • Fax: 505-213-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR24635
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR24635
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberR 24635
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR 24635
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: