Basic Information
| Provider Information | |||||||||
| NPI: | 1932436698 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STANFORD | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | B. | ||||||||
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| Credential: | NP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 802 W DRAKE RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805265567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704820198 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1417 LOCUST ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802202832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7209330333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2009 | ||||||||
| LastUpdateDate: | 05/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NP-10153 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.