Provider Demographics
NPI:1780689000
Name:STAFFORD, ANN MARIE (CNM)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:BOUHASSIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1535 SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1611
Mailing Address - Country:US
Mailing Address - Phone:302-645-4700
Mailing Address - Fax:302-645-1038
Practice Address - Street 1:1535 SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1611
Practice Address - Country:US
Practice Address - Phone:302-645-4700
Practice Address - Fax:302-645-1038
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELK0000126367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000934239Medicaid
DE708777B15Medicare ID - Type UnspecifiedMEDICARE #
DE0000934239Medicaid