Individual
MRS. CONNIE RAE RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4531 SE BELMONT ST STE 100, PORTLAND, OR 97215-1675
(503) 215-9800
(503) 215-9801
Mailing address
4531 SE BELMONT ST STE 100, PORTLAND, OR 97215-1675
(503) 215-9819
(503) 215-9801
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
083040749LPN
OR
Other
Enumeration date
10/11/2012
Last updated
10/11/2012
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