Individual
KHADIJAH RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5429 GERMANTOWN AVE, PHILADELPHIA, PA 19144-2223
(215) 754-0240
Mailing address
4504 PINE ST APT 2E, PHILADELPHIA, PA 19143-6833
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN282234
PA
Other
Enumeration date
07/14/2023
Last updated
07/14/2023
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