Basic Information
| Provider Information | |||||||||
| NPI: | 1275014516 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUNTON | ||||||||
| FirstName: | RANDY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 GOFFS FALLS RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031036109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009952673 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3000 GOFFS FALLS RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031036109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009952673 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2018 | ||||||||
| LastUpdateDate: | 08/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | LPN086421 | GA | N | Nursing Service Providers | Licensed Practical Nurse | 164W00000X | 334490 | CO | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.