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General NPI Number Information
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NPI Number | 1184465148
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Entity Type | Individual
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Provider Name | OLIVIA RANDALL NP-PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 4550 EUBANK BLVD NE STE 107
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-2565
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Country | US
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Telephone | 505-503-8806
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Fax | 888-503-8511
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Provider Business Mailing Address
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Address Line | 1525 N RENAISSANCE BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-6827
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Country | US
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Telephone | 276-734-2799
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 77359
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License Number State | NM
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