Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 641431 | TX |
NPI | 1124178660 |
---|---|
Provider Name | James Randall Radnedge |
First Address | Royse City, TX 75189-3083 |
Second Address | Ft Worth, TX 76104-2122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 08/07/2007 |