Provider Demographics
NPI:1699148734
Name:SNODDY, MAMIE
Entity type:Individual
Prefix:
First Name:MAMIE
Middle Name:
Last Name:SNODDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 W SHERMAN ST UNIT 1091
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-3468
Mailing Address - Country:US
Mailing Address - Phone:612-240-1959
Mailing Address - Fax:
Practice Address - Street 1:1018 W SHERMAN ST UNIT 1091
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-3468
Practice Address - Country:US
Practice Address - Phone:612-240-1959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6069390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program