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General NPI Number Information
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NPI Number | 1235606807
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Entity Type | Individual
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Provider Name | ETIENNETTE GENEVIEVE SNEED FNP
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Gender | Female
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Dates
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Enumeration Date | 10/31/2018
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 500 N US HIGHWAY 89
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City | PRESCOTT
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State | AZ
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Zip | 86313-5001
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Country | US
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Telephone | 928-445-4860
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Fax |
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Provider Business Mailing Address
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Address Line | 500 N HIGHWAY 89 BLDG. 158 RM. 105
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City | PRESCOTT
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State | AZ
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Zip | 86313
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Country | US
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Telephone | 928-445-4860
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 272985
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95010176
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License Number State | CA
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