Provider Demographics
NPI:1205103363
Name:SANFORD, EMILIE E (CRNA)
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:E
Last Name:SANFORD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:EMILIE
Other - Middle Name:E
Other - Last Name:VERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24W621 PARTRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-3750
Mailing Address - Country:US
Mailing Address - Phone:630-862-5841
Mailing Address - Fax:
Practice Address - Street 1:3815 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1500
Practice Address - Country:US
Practice Address - Phone:630-275-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009244367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered