Provider Demographics
NPI:1740896828
Name:SANFORD, LISA MARIE (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SANFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 1256
Mailing Address - Street 2:
Mailing Address - City:WATFORD CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58854-1256
Mailing Address - Country:US
Mailing Address - Phone:701-444-2888
Mailing Address - Fax:701-444-2813
Practice Address - Street 1:340 N MAIN ST STE 311
Practice Address - Street 2:
Practice Address - City:WATFORD CITY
Practice Address - State:ND
Practice Address - Zip Code:58854-7308
Practice Address - Country:US
Practice Address - Phone:701-444-2888
Practice Address - Fax:701-444-2813
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR41879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine