Individual
MADELYNN WHITESIDES RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1756 W ANTELOPE DR, LAYTON, UT 84041-1143
(801) 773-4865
Mailing address
1736 S HAVEN PKWY, WEST HAVEN, UT 84401-7134
(801) 540-8739
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
11565765-4405
UT
Other
Enumeration date
08/18/2023
Last updated
08/18/2023
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