Provider Demographics
NPI:1689103236
Name:SANFORD, MELISSA N (RN, C-EFM)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:N
Last Name:SANFORD
Suffix:
Gender:F
Credentials:RN, C-EFM
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:B
Other - Last Name:NEMESCHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, C-EFM
Mailing Address - Street 1:8625 S GREEN WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-1844
Mailing Address - Country:US
Mailing Address - Phone:801-674-7164
Mailing Address - Fax:
Practice Address - Street 1:5121 S COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5701
Practice Address - Country:US
Practice Address - Phone:801-507-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7873819-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT942854057Medicaid