Provider Demographics
NPI:1558985036
Name:STANFORD, AMANDA (DNP, APRN, A-GNP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:STANFORD
Suffix:
Gender:F
Credentials:DNP, APRN, A-GNP-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:KYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:925 E MC DOWELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006
Mailing Address - Country:US
Mailing Address - Phone:602-867-3800
Mailing Address - Fax:623-285-2710
Practice Address - Street 1:925 E MC DOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-867-3800
Practice Address - Fax:623-285-2710
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ241738363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health