MEDICARE: JOANN K RANDOLPH PHD, FNP, MS, BSN

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	363LA2200X	Adult Health Nurse Practitioner	NP-09144	OH
2	363LF0000X	Family Nurse Practitioner	NP-09144	OH

General Provider Information

NPI Number	:	1891909354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANN K RANDOLPH PHD, FNP, MS, BSN

Provider Business Mailing Address
First Line	:	2415 AUBURN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2701
Country	:	US
Telephone Number	:	513-221-4949
Fax Number	:	513-241-4191

Provider Business Practice Location Address
First Line	:	4027 EASTERN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45226-1747
Country	:	US
Telephone Number	:	513-321-2202
Fax Number	:

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	09/29/2011

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