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NPI Code Detail

MEDICARE: MR. RORY ERIC RANDALL CNP

MEDICARE: MR. RORY ERIC RANDALL CNP
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
1163W00000XRegistered NurseRN.305782-COA1OH
2363LA2200XAdult Health Nurse PractitionerCOA.16607-NPOH

General Provider Information

NPI Number : 1619370905
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RORY ERIC RANDALL CNP
Provider Business Mailing Address
First Line : 11100 EUCLID AVE
Second Line : SEIDMAN CANCER CENTER RM 1830
City : CLEVELAND
State : OH
Zip : 44106-1716
Country : US
Telephone Number : 216-286-3826
Fax Number : 216-286-3864
Provider Business Practice Location Address
First Line : 11100 EUCLID AVE
Second Line : SEIDMAN CANCER CENTER RM 1830
City : CLEVELAND
State : OH
Zip : 44106-1716
Country : US
Telephone Number : 216-286-3826
Fax Number : 216-286-3864
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2014
Last Update Date : 01/12/2021

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