MEDICARE: JENNIFER SANFORD RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	4704277493	MI

General Provider Information

NPI Number	:	1154998714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SANFORD RN

Provider Business Mailing Address
First Line	:	3500 COOLIDGE RD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-6376
Country	:	US
Telephone Number	:	517-203-4042
Fax Number	:	517-203-4043

Provider Business Practice Location Address
First Line	:	3500 COOLIDGE RD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-6376
Country	:	US
Telephone Number	:	517-203-4042
Fax Number	:	517-203-4043

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2021
Last Update Date	:	06/10/2021

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