Provider Demographics
NPI:1518374842
Name:RANDLE, ALICIA
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:RANDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:DUMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 674
Mailing Address - Street 2:
Mailing Address - City:BRICE
Mailing Address - State:OH
Mailing Address - Zip Code:43109-0674
Mailing Address - Country:US
Mailing Address - Phone:603-915-3470
Mailing Address - Fax:
Practice Address - Street 1:6525 WINCHESTER HIGHLANDS DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9475
Practice Address - Country:US
Practice Address - Phone:603-915-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2809018374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2809018OtherINDEPENDENT PROVIDER