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General NPI Number Information
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NPI Number | 1427085760
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Entity Type | Individual
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Provider Name | WYNELLE R SNOW MD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 04/16/2009
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Provider Practice Location Address
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Address Line | 21 JEFFERSON ST SUITE 201
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City | KETCHIKAN
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State | AK
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Zip | 99901-5875
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Country | US
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Telephone | 907-220-9948
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Fax | 907-220-9947
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Provider Business Mailing Address
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Address Line | PO BOX 8202
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City | KETCHIKAN
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State | AK
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Zip | 99901-3202
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Country | US
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Telephone | 907-220-9948
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 1271
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License Number State | AK
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