Provider Demographics
NPI:1760512586
Name:STAFFORD, JOHN D (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2028
Mailing Address - Country:US
Mailing Address - Phone:607-432-5680
Mailing Address - Fax:607-432-5575
Practice Address - Street 1:449 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2028
Practice Address - Country:US
Practice Address - Phone:607-432-5680
Practice Address - Fax:607-432-5575
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169872NP363L00000X
NYF337953-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
511I500824OtherMEDICARE PTAN