Healthcare Provider Details

I. General information

NPI: 1770202913
Provider Name (Legal Business Name): ALICIA STANFORD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 OLD WASHINGTON RD STE 100
WALDORF MD
20602-3249
US

IV. Provider business mailing address

12211 PLUM ORCHARD DR STE 220
SILVER SPRING MD
20904-7919
US

V. Phone/Fax

Practice location:
  • Phone: 301-645-0300
  • Fax:
Mailing address:
  • Phone: 301-754-3060
  • Fax: 301-681-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR229010
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR229010
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: