Provider Demographics
NPI:1104542109
Name:GOLEMAN, RANDY PAUL (ARNP)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:PAUL
Last Name:GOLEMAN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6248 W AIRHORN AVE
Mailing Address - Street 2:
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-8014
Mailing Address - Country:US
Mailing Address - Phone:208-250-0428
Mailing Address - Fax:
Practice Address - Street 1:845 W KATHLEEN AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-9405
Practice Address - Country:US
Practice Address - Phone:208-250-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61409196363LP0808X
IDTEMP58976363LP0808X
TX1112901363LP0808X
HIAPRN-3981363LP0808X
NV865047363LP0808X
ID58976363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health