Provider Demographics
NPI:1609451673
Name:SANFORD, TODD EDWIN (NP)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:EDWIN
Last Name:SANFORD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 E BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8300
Mailing Address - Country:US
Mailing Address - Phone:810-348-3754
Mailing Address - Fax:
Practice Address - Street 1:3306 E BALDWIN RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8300
Practice Address - Country:US
Practice Address - Phone:810-348-3754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704214995363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care