Provider Demographics
NPI:1821478827
Name:BOLEMAN, RANDI M (PHD, RD, LD, CSSD)
Entity Type:Individual
Prefix:DR
First Name:RANDI
Middle Name:M
Last Name:BOLEMAN
Suffix:
Gender:F
Credentials:PHD, RD, LD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9555 ESCONDIDO LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-3037
Mailing Address - Country:US
Mailing Address - Phone:979-255-7673
Mailing Address - Fax:415-738-5450
Practice Address - Street 1:9555 ESCONDIDO LN
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-3037
Practice Address - Country:US
Practice Address - Phone:979-255-7673
Practice Address - Fax:415-738-5450
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80230133V00000X
950484133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered