Individual
AMANDA VIVIAN SANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3449 E REZANOF DR, KODIAK, AK 99615-6952
(907) 486-1367
Mailing address
1623 MILL BAY RD APT 3, KODIAK, AK 99615-6200
(907) 486-0478
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMG225
—
AK
Enumeration date
02/27/2007
Last updated
09/02/2010
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