Individual
SHAWNTA R RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1200
(602) 200-5383
Mailing address
PO BOX 31001-0698, PASADENA, CA 91110-5319
(602) 236-1200
(605) 200-5383
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
NUR-RN-LIC-38864
MT
Other
Enumeration date
05/04/2016
Last updated
05/04/2016
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