Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 036-118933 | IL |
N | 207VG0400X | Gynecologist | C2-0009401 | DE |
NPI | 1134329063 |
---|---|
Provider Name | Rashida Randeree |
First Address | Rockford, IL 61107-6637 |
Second Address | Rockford, IL 61107-6637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 19/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1134329063 | (05) | DE |