| NPI | 1336385525 |
|---|---|
| Former Name | TANJA K RANDALL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2003016241) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: MO 2003016241) |
| Enumeration Date | 2008-12-18 |
| Last Update Date | 2012-04-24 |