Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 26NJ00955700 | NJ |
NPI | 1093364648 |
---|---|
Provider Name | Ms. Randi Killian |
First Address | Plainsboro, NJ 08536-1913 |
Second Address | Plainsboro, NJ 08536-1913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2019 |
Last Update Date | 06/09/2019 |