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Individual

MR. RANDY C. WILLEBY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
1700 MOUNT VERNON AVE, BAKERSFIELD, CA 93306-4018
(661) 326-2128
(661) 326-2129
Mailing address
PO BOX 1843, BAKERSFIELD, CA 93303-1843
(914) 637-3530
(914) 560-2227

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
246857
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
326
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
RN2468570
CA
Enumeration date
01/17/2006
Last updated
10/13/2009
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