Provider Demographics
NPI:1801563226
Name:STANFORD, JOHN SAMUEL (RN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:SAMUEL
Last Name:STANFORD
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Gender:M
Credentials:RN
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Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-202-2093
Mailing Address - Fax:501-202-6316
Practice Address - Street 1:9601 BAPTIST HEALTH DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-202-2093
Practice Address - Fax:501-202-6316
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2023-01-27
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Provider Licenses
StateLicense IDTaxonomies
AR223288367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered