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Individual

MRS. JUDITH MYRICK RANDALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ARNP

Contact information

Practice address
1890 WAITE ST, STE 1, NORTH BEND, OR 97459-1229
(541) 756-6232
(541) 756-6234
Mailing address
1890 WAITE ST, STE 1, NORTH BEND, OR 97459-1229
(541) 756-6232
(541) 756-6234

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201250024
OR
363LF0000X
Family Nurse Practitioner
AP30007876
WA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
201250025NP
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1619915113
WATERFALL CLINIC, INC. GROUP NPI
05
213342
OR
01
R120353
GROUP PTAN NUMBER
Enumeration date
12/13/2007
Last updated
06/22/2012
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