Healthcare Provider Details

I. General information

NPI: 1710866520
Provider Name (Legal Business Name): RANDI STEWARD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 N RANDALL RD STE 210
ELGIN IL
60123-7879
US

IV. Provider business mailing address

1307 OLD HERITAGE PL
GREENWOOD IN
46143-6617
US

V. Phone/Fax

Practice location:
  • Phone: 224-760-7322
  • Fax:
Mailing address:
  • Phone: 812-798-1201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71016601A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: