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General NPI Number Information
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NPI Number | 1902172125
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Entity Type | Individual
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Provider Name | RANDA SUE VAJDAK PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/02/2012
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Last Update Date | 04/02/2012
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Provider Practice Location Address
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Address Line | 3740 COPPERFIELD DR. STE 105
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City | BRYAN
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State | TX
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Zip | 77802
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Country | US
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Telephone | 979-776-1660
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Fax | 979-776-1314
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Provider Business Mailing Address
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Address Line | 3740 COPPERFIELD DR. STE 105
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City | BRYAN
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State | TX
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Zip | 77802
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Country | US
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Telephone | 979-776-1660
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Fax | 979-776-1314
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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 | 364SM0705X
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Taxonomy Name | Medical-Surgical Clinical Nurse Specialist
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License Number | PA02991
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License Number State | TX
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