Individual
WALTER RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LN100692
Contact information
Practice address
1210 MAIN ST, WARREN, MA 01083-9760
(717) 916-0995
Mailing address
PO BOX 6284, BRATTLEBORO, VT 05302-6284
(717) 916-0995
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN100692
MA
Other
Enumeration date
08/25/2022
Last updated
08/25/2022
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