Provider Demographics
NPI:1780151118
Name:RANDOLPH, DAWNITA R (MSN, APRN, NP-C)
Entity type:Individual
Prefix:
First Name:DAWNITA
Middle Name:R
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8703 80TH ST
Mailing Address - Street 2:
Mailing Address - City:NOBLE
Mailing Address - State:OK
Mailing Address - Zip Code:73068-9741
Mailing Address - Country:US
Mailing Address - Phone:405-820-5857
Mailing Address - Fax:
Practice Address - Street 1:8703 80TH ST
Practice Address - Street 2:
Practice Address - City:NOBLE
Practice Address - State:OK
Practice Address - Zip Code:73068-9741
Practice Address - Country:US
Practice Address - Phone:405-820-5857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKF10181005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily