Provider Demographics
NPI:1538239587
Name:SNOW, NICHOLE LYNN (RN, MS, APRN-BC)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:LYNN
Last Name:SNOW
Suffix:
Gender:F
Credentials:RN, MS, APRN-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:1330 BOILING SPRINGS RD
Practice Address - Street 2:SUITE 2500
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303
Practice Address - Country:US
Practice Address - Phone:864-585-5433
Practice Address - Fax:864-591-4053
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC2126163WG0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0828Medicaid
SCSC54346084OtherMEDICARE PIN
SCSC54346121OtherMEDICARE PIN
SCAA05381562Medicare PIN