Provider Demographics
NPI:1922389295
Name:REIDLER, RANDALL MARIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RANDALL
Middle Name:MARIE
Last Name:REIDLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-713-5540
Mailing Address - Fax:336-713-5445
Practice Address - Street 1:WAKE FOREST BAPTIST HEALTH
Practice Address - Street 2:MEDICAL CENTER BLVD
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-713-5440
Practice Address - Fax:336-713-5445
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-03043363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant