Individual
DR. RANDALL DELBERT WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN, CRNA
Contact information
Practice address
10315 DAWSONS CREEK BLVD STE AB, FORT WAYNE, IN 46825-1912
(260) 436-7875
(260) 432-9812
Mailing address
PO BOX 843603, DALLAS, TX 75284-3603
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28246441A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326617937
—
IN
05
—
1326617937
—
OH
Enumeration date
06/18/2021
Last updated
06/24/2024
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