Individual
ELAINE J RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28187658A
IN
367500000X
Certified Registered Nurse Anesthetist
NA2072
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000640369
ANTHEM PROVIDER NUMBER
IN
05
—
200974200
—
IN
Enumeration date
11/29/2006
Last updated
04/27/2010
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