| Doctor Name: | VICKIE S RANDALL |
| NPI Number: | 1184991044 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 591329-1 |
| Business Practice Address: | 11631 Salter Colvin Rd Wolcott, NY - 145909376 |
| Business Phone Number: | 3155943110 |
| Business Fax Number: | 3155946235 |
| Mailing Address: | 11631 Salter Colvin Rd, WOLCOTT |
| State: | NY |
| Postal Code: | 145909376 |
| Phone Number: | 3155943110 |
| Fax Number: | 3155946235 |
| NPI Enumeration Date: | 11/21/2011 |
| NPI Last Update Date: | 11/21/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WS0200X |
| License Number: | 591329-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |