Provider Demographics
NPI:1356820336
Name:FIEBER, RANDALL STUART (RN)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:STUART
Last Name:FIEBER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 ERSKINE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:CA
Mailing Address - Zip Code:93240-9608
Mailing Address - Country:US
Mailing Address - Phone:760-379-2556
Mailing Address - Fax:760-379-1257
Practice Address - Street 1:3240 ERSKINE CREEK RD
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240-9608
Practice Address - Country:US
Practice Address - Phone:760-379-2556
Practice Address - Fax:760-379-1257
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA417982163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool