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General NPI Number Information
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NPI Number | 1497659775
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Entity Type | Individual
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Provider Name | STACEY DIANE SANFORD FNP
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Gender | Female
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Dates
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Enumeration Date | 10/08/2026
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Last Update Date | 10/08/2026
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Provider Practice Location Address
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Address Line | 3023 DUPORTAIL ST STE C
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City | RICHLAND
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State | WA
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Zip | 99352-6103
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Country | US
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Telephone | 209-450-6833
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Fax |
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Provider Business Mailing Address
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Address Line | 2313 OLYMPIA ST
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City | RICHLAND
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State | WA
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Zip | 99354-3042
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Country | US
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Telephone | 509-420-9178
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP70032417
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License Number State | WA
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