Individual
LISA MICHELLE SANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
618 COUNTY ROAD 5031, BOONEVILLE, MS 38829-9410
(662) 365-0200
(662) 365-0199
Mailing address
618 COUNTY ROAD 5031, BOONEVILLE, MS 38829-9410
(901) 261-4848
(901) 261-4867
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R867344
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09520566
—
MS
Enumeration date
11/17/2010
Last updated
04/19/2018
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