Provider Demographics
NPI:1801123849
Name:RANDAZZO, REBECCA L (APRN)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:L
Last Name:RANDAZZO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:L
Other - Last Name:MACDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31 SYCAMORE ST
Mailing Address - Street 2:SUITE 201-B
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4540
Mailing Address - Country:US
Mailing Address - Phone:860-659-0629
Mailing Address - Fax:860-714-6698
Practice Address - Street 1:31 SYCAMORE ST
Practice Address - Street 2:SUITE 201-B
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4540
Practice Address - Country:US
Practice Address - Phone:860-659-0629
Practice Address - Fax:860-714-6698
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily