Healthcare Provider Details

I. General information

NPI: 1104396324
Provider Name (Legal Business Name): SNOW FAMILY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 PLAINFIELD PIKE
CRANSTON RI
02921-2031
US

IV. Provider business mailing address

23 ARROWHEAD TRL
NORTH SCITUATE RI
02857-2846
US

V. Phone/Fax

Practice location:
  • Phone: 401-585-8500
  • Fax: 401-942-2200
Mailing address:
  • Phone: 401-585-8500
  • Fax: 401-942-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN ANN SNOW
Title or Position: PROVIDER
Credential: APRN, FNP-BC, NP-C
Phone: 401-585-8500