Provider Demographics
NPI:1427787498
Name:SANFORD, AMANDA L (NP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:SANFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-1626
Mailing Address - Country:US
Mailing Address - Phone:419-678-5271
Mailing Address - Fax:
Practice Address - Street 1:03920 SOUTHLAND RD
Practice Address - Street 2:
Practice Address - City:NEW BREMEN
Practice Address - State:OH
Practice Address - Zip Code:45869-9790
Practice Address - Country:US
Practice Address - Phone:419-629-2772
Practice Address - Fax:419-629-3613
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031634363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily