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Individual

AMANDA RANDALL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2201 THREE MILE RD, URBANA, OH 43078-9744
(937) 869-5771
Mailing address
2201 THREE MILE RD, URBANA, OH 43078-9744
(937) 869-5771

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
RS488736
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
RS488736
DRIVER
OH
Enumeration date
10/11/2022
Last updated
10/11/2022
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