Provider Demographics
NPI:1194331538
Name:HARPER-MOULTON, SNOW VERDEAN (RN IBCLC)
Entity type:Individual
Prefix:
First Name:SNOW
Middle Name:VERDEAN
Last Name:HARPER-MOULTON
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 COUNTY ROUTE 37
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-3362
Mailing Address - Country:US
Mailing Address - Phone:315-600-1007
Mailing Address - Fax:
Practice Address - Street 1:428 COUNTY ROUTE 37
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-3362
Practice Address - Country:US
Practice Address - Phone:315-600-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY476483163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant