Individual
MR. RANDY CARL WARNDAHL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1105 OAKRIDGE MANOR DR, BRANDON, FL 33511-7654
(813) 418-0075
Mailing address
1105 OAKRIDGE MANOR DR, BRANDON, FL 33511-7654
(813) 418-0075
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
W653-723-65-097-0
FL
343900000X
Non-emergency Medical Transport (VAN)
Primary
W653-723-65-097-0
FL
Other
Enumeration date
01/30/2012
Last updated
01/30/2012
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