Provider Demographics
NPI:1588327803
Name:RANDY NOLF PC
Entity type:Organization
Organization Name:RANDY NOLF PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VERSOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-420-1500
Mailing Address - Street 1:106 SKINNER HILL RD
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-7505
Mailing Address - Country:US
Mailing Address - Phone:570-420-1500
Mailing Address - Fax:
Practice Address - Street 1:106 SKINNER HILL RD
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7505
Practice Address - Country:US
Practice Address - Phone:570-420-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment