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General NPI Number Information
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NPI Number | 1326680596
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Entity Type | Individual
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Provider Name | KATHLEEN VAJDA SNOW
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Gender | Female
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Dates
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Enumeration Date | 10/09/2019
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 713 S MARSHALL ST
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City | WINSTON SALEM
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State | NC
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Zip | 27101-5808
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Country | US
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Telephone | 336-722-7266
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Fax | 336-201-0538
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Provider Business Mailing Address
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Address Line | 713 S MARSHALL ST
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City | WINSTON SALEM
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State | NC
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Zip | 27101-5808
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Country | US
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Telephone | 336-722-7266
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Fax | 336-201-0538
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 299062
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AC003827
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5012939
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License Number State | NC
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