MEDICARE: MR. RANDALL STUART FIEBER RN

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	163WS0200X	School Registered Nurse	417982	CA

General Provider Information

NPI Number	:	1356820336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RANDALL STUART FIEBER RN

Provider Business Mailing Address
First Line	:	3240 ERSKINE CREEK RD
Second Line	:
City	:	LAKE ISABELLA
State	:	CA
Zip	:	93240-9608
Country	:	US
Telephone Number	:	760-379-2556
Fax Number	:	760-379-1257

Provider Business Practice Location Address
First Line	:	3240 ERSKINE CREEK RD
Second Line	:
City	:	LAKE ISABELLA
State	:	CA
Zip	:	93240-9608
Country	:	US
Telephone Number	:	760-379-2556
Fax Number	:	760-379-1257

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

Provider Enumeration Date	:	08/09/2018
Last Update Date	:	08/09/2018

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