MEDICARE: MS. AMANDA E SANFORD C.P.M., L.M.

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	176B00000X	Midwife	10071R	NM

General Provider Information

NPI Number	:	1932425931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA E SANFORD C.P.M., L.M.

Provider Business Mailing Address
First Line	:	18201 S HIGHWAY 28
Second Line	:
City	:	LA MESA
State	:	NM
Zip	:	88044-9471
Country	:	US
Telephone Number	:	715-574-3690
Fax Number	:

Provider Business Practice Location Address
First Line	:	18201 S HIGHWAY 28
Second Line	:
City	:	LA MESA
State	:	NM
Zip	:	88044-9471
Country	:	US
Telephone Number	:	715-574-3690
Fax Number	:

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

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	04/15/2010

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