Provider Demographics
NPI:1740238617
Name:RANDALL, NANCY JANE (RN, NP-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JANE
Last Name:RANDALL
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SEARS DR
Mailing Address - Street 2:STE 104
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3525
Mailing Address - Country:US
Mailing Address - Phone:770-734-0999
Mailing Address - Fax:770-734-0037
Practice Address - Street 1:2078 BEAVER RUIN RD
Practice Address - Street 2:SUITE 500
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-3765
Practice Address - Country:US
Practice Address - Phone:770-734-0999
Practice Address - Fax:770-734-0037
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00258000363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health