Healthcare Provider Details

I. General information

NPI: 1215695044
Provider Name (Legal Business Name): RANDIE KUHAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 KING RD
IMMACULATA PA
19345-9903
US

IV. Provider business mailing address

506A S MAIN RD
MOUNTAIN TOP PA
18707-2205
US

V. Phone/Fax

Practice location:
  • Phone: 570-899-6334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: