Provider Demographics
NPI:1750353231
Name:SANFORD, LAURA (CNP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:SANFORD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OLD RIVER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9503
Mailing Address - Country:US
Mailing Address - Phone:661-663-4800
Mailing Address - Fax:661-663-4871
Practice Address - Street 1:300 OLD RIVER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9503
Practice Address - Country:US
Practice Address - Phone:661-663-4800
Practice Address - Fax:661-663-4871
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA368191363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ72627ZMedicare ID - Type Unspecified