Provider Demographics
NPI:1366423956
Name:SNOW, EVANGELINA U (MD)
Entity type:Individual
Prefix:
First Name:EVANGELINA
Middle Name:U
Last Name:SNOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2370 CORPORATE CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7760
Mailing Address - Country:US
Mailing Address - Phone:702-910-3950
Mailing Address - Fax:702-786-6650
Practice Address - Street 1:100 N GREEN VALLEY PKWY STE 239
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7704
Practice Address - Country:US
Practice Address - Phone:702-844-4841
Practice Address - Fax:702-844-4844
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2021-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV9875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018825Medicaid
NV9875OtherNEVADA LICENSE NUMBER
NVV100938Medicare PIN
NV9875OtherNEVADA LICENSE NUMBER