Provider Demographics
NPI:1356123020
Name:MILES, RANDA LAWRENCE (RN)
Entity type:Individual
Prefix:MRS
First Name:RANDA
Middle Name:LAWRENCE
Last Name:MILES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 KEMP XING
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5004
Mailing Address - Country:US
Mailing Address - Phone:757-402-0629
Mailing Address - Fax:
Practice Address - Street 1:908 KEMP XING
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5004
Practice Address - Country:US
Practice Address - Phone:757-402-0629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001212149163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse