Provider Demographics
NPI:1194744748
Name:SNELGROVE, MARY DODICH (FNP-C, MSN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:DODICH
Last Name:SNELGROVE
Suffix:
Gender:F
Credentials:FNP-C, MSN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:M
Other - Last Name:DODICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2767 OLIVE HWY
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-6118
Mailing Address - Country:US
Mailing Address - Phone:530-532-8584
Mailing Address - Fax:530-532-8272
Practice Address - Street 1:2767 OLIVE HWY
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6118
Practice Address - Country:US
Practice Address - Phone:530-532-8584
Practice Address - Fax:530-532-8272
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11984NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ15808ZMedicaid
CAZZZ15808ZMedicaid
CAZZZ15808ZMedicaid