MEDICARE: MS. LISA ANN SANFORD MSN FNP

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	363LF0000X	Family Nurse Practitioner	105289	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225188196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA ANN SANFORD MSN FNP

Provider Business Mailing Address
First Line	:	125 TALLY HO DR
Second Line	:
City	:	SELMA
State	:	NC
Zip	:	27576-8451
Country	:	US
Telephone Number	:	919-965-4459
Fax Number	:

Provider Business Practice Location Address
First Line	:	3305 SUNGATE BLVD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-2871
Country	:	US
Telephone Number	:	919-212-0129
Fax Number	:	919-255-1540

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	03/29/2013

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