Provider Demographics
NPI:1528191475
Name:SANDFORD, MARY ALICE B (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MARY ALICE
Middle Name:B
Last Name:SANDFORD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ALICE
Other - Last Name:SANDFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P O BOX 74166
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-4166
Mailing Address - Country:US
Mailing Address - Phone:410-329-1070
Mailing Address - Fax:410-329-1054
Practice Address - Street 1:11921 ROCKVILLE PIKE
Practice Address - Street 2:STE 505
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2737
Practice Address - Country:US
Practice Address - Phone:301-881-7246
Practice Address - Fax:301-881-2449
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR078363363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR078363OtherMD LICENSE