Provider Demographics
NPI:1538684758
Name:CECIL, RANDI LYNN
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:LYNN
Last Name:CECIL
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 1:1521 WEAVER RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1231
Mailing Address - Country:US
Mailing Address - Phone:419-603-1773
Mailing Address - Fax:
Practice Address - Street 1:1521 WEAVER DR.
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001
Practice Address - Country:US
Practice Address - Phone:419-603-1773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4701997OtherDODD