Individual
MEGHAN SPROUSE RANDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
230 BROWNS WAY RD, MIDLOTHIAN, VA 23114-9501
(804) 419-9101
Mailing address
2827 PRESTON PARK WAY, SANDY HOOK, VA 23153
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110008844
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110008844
LICENSE
VA
Enumeration date
04/11/2022
Last updated
11/01/2023
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