| Doctor Name: | CHERYL LYNN RANDOLPH |
| NPI Number: | 1073694543 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | F.N.P. |
| License Number: | 423561 |
| Business Practice Address: | 250 Bon Air Rd Greenbrae, CA - 949041702 |
| Business Phone Number: | 4154481500 |
| Business Fax Number: | 4154614229 |
| Mailing Address: | 300 Professional Center Dr, Suite 311 NOVATO |
| State: | CA |
| Postal Code: | 949474334 |
| Phone Number: | 4154481500 |
| Fax Number: | 4158928732 |
| NPI Enumeration Date: | 10/18/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 423561 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |