Individual
KIMBERLY NICOLE STANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
701 W NORTH AVE, ANESTHESIA DEPARTMENT, MELROSE PARK, IL 60160-1612
(708) 681-7859
Mailing address
6626 S KIMBARK AVE, UNIT 1N, CHICAGO, IL 60637-4488
(708) 710-7784
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
041347741
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209009397
IL
Other
Enumeration date
11/16/2011
Last updated
04/20/2022
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