Provider Demographics
NPI:1225799539
Name:RANDALL, ARNIESHA M
Entity Type:Individual
Prefix:
First Name:ARNIESHA
Middle Name:M
Last Name:RANDALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 RIO GRANDE DR APT 2004
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6748
Mailing Address - Country:US
Mailing Address - Phone:314-456-9791
Mailing Address - Fax:
Practice Address - Street 1:1515 RIO GRANDE DR APT 2004
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6748
Practice Address - Country:US
Practice Address - Phone:314-456-9791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-08
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier