Provider Demographics
NPI:1184617011
Name:SNODGRASS, MARCIA MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:MARIE
Last Name:SNODGRASS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20854 SW 213 RD
Mailing Address - Street 2:
Mailing Address - City:JETMORE
Mailing Address - State:KS
Mailing Address - Zip Code:67854-5358
Mailing Address - Country:US
Mailing Address - Phone:620-357-6428
Mailing Address - Fax:620-408-9701
Practice Address - Street 1:2200 SUMMERLON CIR
Practice Address - Street 2:SUITE A
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2900
Practice Address - Country:US
Practice Address - Phone:620-408-9700
Practice Address - Fax:620-408-9701
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45402363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100428160AMedicaid
KS100428160AMedicaid
KS102461Medicare ID - Type Unspecified