Healthcare Provider Details

I. General information

NPI: 1164341590
Provider Name (Legal Business Name): TESA E SANFORD-FOX LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

25308 66TH AVE E
GRAHAM WA
98338-9592
US

IV. Provider business mailing address

25308 66TH AVE E
GRAHAM WA
98338-9592
US

V. Phone/Fax

Practice location:
  • Phone: 253-579-2581
  • Fax:
Mailing address:
  • Phone: 253-579-2581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.LP.60616660
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: