Provider Demographics
NPI:1821409467
Name:RANDALL, ANDREA M (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:RANDALL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:WOODSMALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6983 HILLSDALE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2054
Mailing Address - Country:US
Mailing Address - Phone:317-849-8350
Mailing Address - Fax:317-576-6311
Practice Address - Street 1:8402 HARCOURT RD STE 615
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2055
Practice Address - Country:US
Practice Address - Phone:317-806-6991
Practice Address - Fax:317-806-6990
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28179360A163W00000X, 363LF0000X
IN71004999A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001082384OtherANTHEM BCBS