Healthcare Provider Details

I. General information

NPI: 1639562275
Provider Name (Legal Business Name): LAURA SNIZEK RAMIREZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA MELISSA SNIZEK

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 CALLAHAN RD
NORTH KINGSTOWN RI
02852-7739
US

IV. Provider business mailing address

308 CALLAHAN RD
NORTH KINGSTOWN RI
02852-7739
US

V. Phone/Fax

Practice location:
  • Phone: 401-295-9706
  • Fax: 401-295-0920
Mailing address:
  • Phone: 401-295-9706
  • Fax: 401-295-0920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00798
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: