Individual
ANDREA M RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
8402 HARCOURT RD STE 615, INDIANAPOLIS, IN 46260-2055
(317) 806-6991
(317) 806-6990
Mailing address
6983 HILLSDALE CT, INDIANAPOLIS, IN 46250-2054
(317) 849-8350
(317) 576-6311
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28179360A
IN
363LF0000X
Family Nurse Practitioner
28179360A
IN
363LF0000X
Family Nurse Practitioner
Primary
71004999A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001082384
ANTHEM BCBS
IN
Enumeration date
05/16/2014
Last updated
03/25/2021
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