Provider Demographics
NPI:1114492170
Name:RANDLE, RAISHAUN EVETT (LVN)
Entity Type:Individual
Prefix:
First Name:RAISHAUN
Middle Name:EVETT
Last Name:RANDLE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:RAISHAUN
Other - Middle Name:EVETT
Other - Last Name:MATHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:308 N GOLDENWAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN AUGUSTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75972-1845
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:308 N GOLDENWAY ST
Practice Address - Street 2:
Practice Address - City:SAN AUGUSTINE
Practice Address - State:TX
Practice Address - Zip Code:75972-1845
Practice Address - Country:US
Practice Address - Phone:936-201-6269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324626164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse