MEDICARE: BRYNA NICOLE RANDALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	401553260713	OH

General Provider Information

NPI Number	:	1134670847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYNA NICOLE RANDALL

Provider Business Mailing Address
First Line	:	3396 E 121ST ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-4302
Country	:	US
Telephone Number	:	216-804-6390
Fax Number	:

Provider Business Practice Location Address
First Line	:	3396 E 121ST ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-4302
Country	:	US
Telephone Number	:	216-804-6390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2016
Last Update Date	:	10/18/2016

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Directions to “ BRYNA NICOLE RANDALL ” Practice Location

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