Individual
SANDRA RENAE RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4595
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4595
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
23138
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407812365
NBMC MAIN GROUP NPI
OR
01
—
161133
NBMC GROUP MEDICAID-DMAP
OR
05
—
500600529
—
OR
01
—
930635514
NBMC GROUP TAX ID FOR BILLING
OR
01
—
R0000WFBTV
NBMC GROUP MEDICARE
OR
Enumeration date
09/29/2008
Last updated
12/21/2010
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