Provider Demographics
NPI:1053938100
Name:SNOWDON, KIMBERLY COLLEEN (CNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:COLLEEN
Last Name:SNOWDON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:THIMG PRIMARY CARE - SOUTHEAST LIVONIA
Practice Address - Street 2:29370 PLYMOUTH RD STE 100
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48150
Practice Address - Country:US
Practice Address - Phone:734-655-8200
Practice Address - Fax:734-655-8210
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704241334363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Medicaid