MEDICARE: JOYCE ANN RANDOLPH

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1669067666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE ANN RANDOLPH

Provider Business Mailing Address
First Line	:	6615 W 79TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-2043
Country	:	US
Telephone Number	:	317-730-7746
Fax Number	:	317-602-7455

Provider Business Practice Location Address
First Line	:	6615 W 79TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-2043
Country	:	US
Telephone Number	:	317-730-7746
Fax Number	:	317-602-7455

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

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	03/02/2021

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Directions to “ JOYCE ANN RANDOLPH ” Practice Location

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