Provider Demographics
NPI:1013646512
Name:STAFFORD, AMY IRENE (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:IRENE
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:72 MUNJOY ST APT 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2096
Mailing Address - Country:US
Mailing Address - Phone:206-579-1025
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMHALL ST BLDG ROOM1147
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3175
Practice Address - Country:US
Practice Address - Phone:207-662-6773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MECNS204003364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist