Basic Information
| Provider Information | |||||||||
| NPI: | 1538811377 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RANDALL | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | EVAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 N MEDICAL DRIVE UNC-CH SON: CARRINGTON HALL | ||||||||
| Address2: | UNIVERSITY OF NORTH CAROLINA- SCHOOL OF NURSING | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199664260 | ||||||||
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| Practice Location | |||||||||
| Address1: | 120 N MEDICAL DRIVE UNC-CH SON: CARRINGTON HALL | ||||||||
| Address2: | UNIVERSITY OF NORTH CAROLINA- SCHOOL OF NURSING | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199664260 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2022 | ||||||||
| LastUpdateDate: | 01/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 318684 | NC | N | Nursing Service Providers | Registered Nurse | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.