MEDICARE: TIFFANY S RANDICH RN

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	163WX0200X	Oncology Registered Nurse	RN.RN.60802933	WA

General Provider Information

NPI Number	:	1710816772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY S RANDICH RN

Provider Business Mailing Address
First Line	:	4525 3RD AVE SE
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98503-1010
Country	:	US
Telephone Number	:	360-580-4739
Fax Number	:	360-412-8955

Provider Business Practice Location Address
First Line	:	4525 3RD AVE SE
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98503-1010
Country	:	US
Telephone Number	:	360-754-3934
Fax Number	:

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

Provider Enumeration Date	:	05/15/2026
Last Update Date	:	05/15/2026

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