Provider Demographics
NPI:1861810343
Name:RANDOLPH, TAMERA (RN)
Entity type:Individual
Prefix:MRS
First Name:TAMERA
Middle Name:
Last Name:RANDOLPH
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 1:201 W RAMSEUR DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29702-1824
Mailing Address - Country:US
Mailing Address - Phone:864-206-2433
Mailing Address - Fax:864-839-2960
Practice Address - Street 1:201 W. RAMSEUR DR.
Practice Address - Street 2:
Practice Address - City:BLACKBURG
Practice Address - State:SC
Practice Address - Zip Code:29702
Practice Address - Country:US
Practice Address - Phone:864-206-2433
Practice Address - Fax:864-839-2960
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC206138163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool