Provider Demographics
NPI:1215456603
Name:RANDLE, ZELDA
Entity type:Individual
Prefix:
First Name:ZELDA
Middle Name:
Last Name:RANDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ZELDA
Other - Middle Name:
Other - Last Name:RANDLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1003 PARKWAY TER
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-4761
Mailing Address - Country:US
Mailing Address - Phone:972-291-0805
Mailing Address - Fax:
Practice Address - Street 1:1003 PARKWAY TER
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-4761
Practice Address - Country:US
Practice Address - Phone:972-291-0805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX$$$$$$$$$OtherMEDICAL AID