Provider Demographics
NPI:1356320055
Name:SANFORD, TERESA ANNE (DNP, CNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANNE
Last Name:SANFORD
Suffix:
Gender:F
Credentials:DNP, CNP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:A
Other - Last Name:STANKOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN CNP
Mailing Address - Street 1:403 STAGELINE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7848
Mailing Address - Country:US
Mailing Address - Phone:651-772-6251
Mailing Address - Fax:651-224-9661
Practice Address - Street 1:N20W22961 WATERTOWN RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1306
Practice Address - Country:US
Practice Address - Phone:262-875-5070
Practice Address - Fax:866-384-9486
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1515154363LF0000X
WI4689-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN899771045344OtherPREFERRED ONE
MN482426100Medicaid
MN135413OtherUCARE
MN1356320055OtherMEDICA
MN482426100Medicaid
500004265Medicare PIN
MN899771045344OtherPREFERRED ONE