Provider Demographics
NPI:1356059307
Name:NFOR, RANDY NGARRY (LPN)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:NGARRY
Last Name:NFOR
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 IVY RD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45315-6515
Mailing Address - Country:US
Mailing Address - Phone:937-241-5537
Mailing Address - Fax:
Practice Address - Street 1:2025 IVY RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:OH
Practice Address - Zip Code:45315-6515
Practice Address - Country:US
Practice Address - Phone:937-241-5537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH138451164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty