Provider Demographics
NPI:1376726596
Name:FLEXNER, RANDI SUE (FNP, DNP)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:SUE
Last Name:FLEXNER
Suffix:
Gender:F
Credentials:FNP, DNP
Other - Prefix:
Other - First Name:RANDI
Other - Middle Name:S
Other - Last Name:FLEXNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP, DNP
Mailing Address - Street 1:1 CVS DR
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-6146
Mailing Address - Country:US
Mailing Address - Phone:401-770-5779
Mailing Address - Fax:
Practice Address - Street 1:360 ROUTE 73 S
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-596-7019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06622200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ027704XVAMedicare UPIN