Individual
BLAKE RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
604 WEST ST, REINBECK, IA 50669-1353
(319) 575-0180
Mailing address
604 WEST ST, REINBECK, IA 50669-1353
(319) 575-0180
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
A156287
IA
363LF0000X
Family Nurse Practitioner
A156287
IA
Other
Enumeration date
08/20/2019
Last updated
08/21/2025
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