Provider Demographics
NPI:1982109526
Name:RANDLE, MIA DAWN (RN)
Entity Type:Individual
Prefix:MS
First Name:MIA
Middle Name:DAWN
Last Name:RANDLE
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 1:175 JIM ALLEN BLAKE RD
Mailing Address - Street 2:
Mailing Address - City:CEDARBLUFF
Mailing Address - State:MS
Mailing Address - Zip Code:39741-7022
Mailing Address - Country:US
Mailing Address - Phone:662-307-7099
Mailing Address - Fax:
Practice Address - Street 1:175 JIM ALLEN BLAKE RD
Practice Address - Street 2:
Practice Address - City:CEDARBLUFF
Practice Address - State:MS
Practice Address - Zip Code:39741-7022
Practice Address - Country:US
Practice Address - Phone:662-307-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care