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General NPI Number Information
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NPI Number | 1740238617
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Entity Type | Individual
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Provider Name | NANCY JANE RANDALL RN, NP-C
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Gender | Female
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 2078 BEAVER RUIN RD SUITE 500
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City | NORCROSS
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State | GA
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Zip | 30071-3765
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Country | US
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Telephone | 770-734-0999
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Fax | 770-734-0037
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Provider Business Mailing Address
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Address Line | 2 SEARS DR STE 104
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City | PARAMUS
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State | NJ
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Zip | 07652-3525
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Country | US
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Telephone | 770-734-0999
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Fax | 770-734-0037
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 26NJ00258000
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License Number State | NJ
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