Individual
PATRICIA EILEEN RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
2006 MAIN STREET, VANCOUVER, WA 98660
(360) 906-0826
Mailing address
1806 NE 177TH AVE, VANCOUVER, WA 98684
(360) 334-5116
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60070315
WA
Other
Enumeration date
10/19/2010
Last updated
10/19/2010
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