Individual
DR. RANDALL E WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC, MSN, ARNP
Contact information
Practice address
23511 HOLLYWOOD RD STE 2, LEONARDTOWN, MD 20650-5922
(301) 997-0611
(855) 253-1610
Mailing address
23511 HOLLYWOOD RD STE 2, LEONARDTOWN, MD 20650-5922
(301) 997-0611
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
0104556249
VA
363LF0000X
Family Nurse Practitioner
Primary
R268981
MD
363LP2300X
Primary Care Nurse Practitioner
R268981
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0104556249
VA STATE LICENSE
VA
01
—
R268981
MARYLAND STATE LICENSE
MD
Enumeration date
08/31/2006
Last updated
04/22/2025
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