Healthcare Provider Details

I. General information

NPI: 1558644401
Provider Name (Legal Business Name): MARILYN LOUISE SNOW R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LORALEE DR
ALBANY NY
12205-2223
US

IV. Provider business mailing address

100 LORALEE DR
ALBANY NY
12205-2223
US

V. Phone/Fax

Practice location:
  • Phone: 518-456-2608
  • Fax: 518-862-0271
Mailing address:
  • Phone: 518-456-2608
  • Fax: 518-862-0271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2481671
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: