Basic Information
| Provider Information | |||||||||
| NPI: | 1790110419 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SNODGRASS | ||||||||
| FirstName: | NIKKI | ||||||||
| MiddleName: | DANAE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8201 HEALTHCARE LOOP | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282157072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9803021000 | ||||||||
| FaxNumber: | 9803021001 | ||||||||
| Practice Location | |||||||||
| Address1: | 8201 HEALTHCARE LOOP | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282157072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9803021000 | ||||||||
| FaxNumber: | 9803021001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2013 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 90747 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.