Organization
JENNIFER NANETTLE RANDOLPH LLC
Active
Other names
MIZZALLTHAT SPA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER NANETTLE RANDOLPH BM (MANAGER)
(414) 304-4881
Entity
Organization
Contact information
Practice address
7715 S COTTAGE GROVE, STE, 1 DPT 198502, CHICAGO, IL 60619
(414) 304-4881
Mailing address
7715 S COTTAGE GROVE, STE, 1 DPT 198502, CHICAGO, IL 60619
(414) 304-4881
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
332U00000X
Home Delivered Meals
—
—
347C00000X
Private Vehicle
Primary
—
—
Other
Enumeration date
02/02/2024
Last updated
02/02/2024
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