Provider Demographics
NPI:1699586511
Name:RANDOL, WHITNEY (JANUARY 7, 2025)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:RANDOL
Suffix:
Gender:F
Credentials:JANUARY 7, 2025
Other - Prefix:
Other - First Name:WHINEY
Other - Middle Name:
Other - Last Name:RANDOL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JANUARY 17, 2025
Mailing Address - Street 1:858 CIMARRON DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8994
Mailing Address - Country:US
Mailing Address - Phone:720-340-5732
Mailing Address - Fax:
Practice Address - Street 1:858 CIMARRON DR UNIT B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8994
Practice Address - Country:US
Practice Address - Phone:720-340-5732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1049374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula