Provider Demographics
NPI:1538337407
Name:SANFORD, JANET LYNN (FNP)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:LYNN
Last Name:SANFORD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1021 W HAMLET AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-4564
Mailing Address - Country:US
Mailing Address - Phone:910-582-5166
Mailing Address - Fax:910-582-5168
Practice Address - Street 1:1021 W HAMLET AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-4564
Practice Address - Country:US
Practice Address - Phone:910-582-5166
Practice Address - Fax:910-582-5168
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004673Medicaid
NC7004673Medicaid