Individual
BRYCE ALDWORTH RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 779-3366
Mailing address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN193141
AZ
367500000X
Certified Registered Nurse Anesthetist
Primary
233389
AZ
Other
Enumeration date
09/03/2019
Last updated
09/11/2020
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