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NPI Code Detail

MEDICARE: MELINDA J STANFORD FNP

MEDICARE: MELINDA J STANFORD 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
1363L00000XNurse Practitioner1957034405UT

General Provider Information

NPI Number : 1780638973
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELINDA J STANFORD FNP
Provider Business Mailing Address
First Line : 450 WILLIAMS WAY
Second Line : PO BOX 998
City : MOAB
State : UT
Zip : 84532-2065
Country : US
Telephone Number : 435-719-3508
Fax Number : 435-719-3509
Provider Business Practice Location Address
First Line : 476 WILLIAMS WAY
Second Line :
City : MOAB
State : UT
Zip : 84532-2065
Country : US
Telephone Number : 435-719-5500
Fax Number : 435-719-5501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 03/02/2012

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Directions to “ MELINDA J STANFORD FNP” Practice Location

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