Individual
CRISTA RANDOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
7333 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6280
(260) 458-3825
Mailing address
8210 SURREY CT, FORT WAYNE, IN 46815-8777
(260) 450-9535
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71009114A
IN
Other
Enumeration date
07/10/2019
Last updated
07/10/2019
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