Provider Demographics
NPI:1073002515
Name:SANFORD, MEGAN LYNN (CRNP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LYNN
Last Name:SANFORD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5750
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-0750
Mailing Address - Country:US
Mailing Address - Phone:256-355-9040
Mailing Address - Fax:256-355-9048
Practice Address - Street 1:2422 DANVILLE RD SW STE E
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4221
Practice Address - Country:US
Practice Address - Phone:256-355-9040
Practice Address - Fax:256-355-9048
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-131174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily