Provider Demographics
NPI:1629773213
Name:EARLS, RANDY LEE
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:LEE
Last Name:EARLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9817 CRUSADER DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-1613
Mailing Address - Country:US
Mailing Address - Phone:513-970-5513
Mailing Address - Fax:
Practice Address - Street 1:9817 CRUSADER DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-1613
Practice Address - Country:US
Practice Address - Phone:513-970-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide