MEDICARE: YOLANDA RANDALL LPN

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		OH
2	172A00000X	Driver		OH

General Provider Information

NPI Number	:	1861739633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOLANDA RANDALL LPN

Provider Business Mailing Address
First Line	:	20390 S LAKE SHORE BLVD
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-2135
Country	:	US
Telephone Number	:	216-855-2650
Fax Number	:

Provider Business Practice Location Address
First Line	:	20390 S LAKE SHORE BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44123-2135
Country	:	US
Telephone Number	:	216-855-2650
Fax Number	:

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

Provider Enumeration Date	:	01/13/2013
Last Update Date	:	12/11/2025

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