Healthcare Provider Details

I. General information

NPI: 1790390599
Provider Name (Legal Business Name): QUANIQUE SNOW LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 ROUSSEAU DR
WEBSTER NY
14580-4121
US

IV. Provider business mailing address

1038 ROUSSEAU DR
WEBSTER NY
14580-4121
US

V. Phone/Fax

Practice location:
  • Phone: 585-748-9076
  • Fax:
Mailing address:
  • Phone: 585-748-9076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number974653
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number330370-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: