Provider Demographics
NPI:1932425931
Name:SANFORD, AMANDA E (CPM, LM)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:E
Last Name:SANFORD
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18201 S HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:NM
Mailing Address - Zip Code:88044-9471
Mailing Address - Country:US
Mailing Address - Phone:715-574-3690
Mailing Address - Fax:
Practice Address - Street 1:18201 S HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:NM
Practice Address - Zip Code:88044-9471
Practice Address - Country:US
Practice Address - Phone:715-574-3690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM10071R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife