Healthcare Provider Details

I. General information

NPI: 1255734315
Provider Name (Legal Business Name): MELISSA RANDLEMAN BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E WENDOVER AVE
GREENSBORO NC
27405-6713
US

IV. Provider business mailing address

1100 E WENDOVER AVE
GREENSBORO NC
27405-6713
US

V. Phone/Fax

Practice location:
  • Phone: 336-641-7511
  • Fax: 336-641-6603
Mailing address:
  • Phone: 336-641-7511
  • Fax: 336-641-6603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number197500
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: