Provider Demographics
NPI:1306373923
Name:RANDALL, VANESSA
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:RANDALL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VANESSA
Other - Middle Name:RENA
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2150 KATY FORT BEND RD
Mailing Address - Street 2:311
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2786
Mailing Address - Country:US
Mailing Address - Phone:832-729-6342
Mailing Address - Fax:
Practice Address - Street 1:2150 KATY FORT BEND RD
Practice Address - Street 2:311
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2786
Practice Address - Country:US
Practice Address - Phone:832-729-6342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health