Provider Demographics
NPI:1770356669
Name:YOW, RANDI DIANE (RDN)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:DIANE
Last Name:YOW
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 DUNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-2146
Mailing Address - Country:US
Mailing Address - Phone:405-630-0691
Mailing Address - Fax:
Practice Address - Street 1:1243 DUNSTON AVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-2146
Practice Address - Country:US
Practice Address - Phone:405-630-0691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL86031859133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered