Provider Demographics
NPI:1942783287
Name:STANFORD, KARL WILSON (APRN)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:WILSON
Last Name:STANFORD
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:NH
Mailing Address - Zip Code:03741-0550
Mailing Address - Country:US
Mailing Address - Phone:603-523-4343
Mailing Address - Fax:866-277-5893
Practice Address - Street 1:18 ROBERTS ROAD
Practice Address - Street 2:
Practice Address - City:CANAAN
Practice Address - State:NH
Practice Address - Zip Code:03741
Practice Address - Country:US
Practice Address - Phone:603-523-4343
Practice Address - Fax:866-277-5893
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH059008-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily