Individual provider Active NPI

Cheryl Lynn Randolph, F.N.P.

  • Family Nurse Practitioner
  • Greenbrae, CA
National Provider Identifier
1073694543
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
423561 Issued in CA
Practice address
250 Bon Air Rd
Greenbrae, CA 94904-1702
Phone
(415) 448-1500
Fax
(415) 461-4229
NPI assigned
Oct 18, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 423561 CA Primary

Addresses

Primary practice location

250 Bon Air Rd
Greenbrae, CA 94904-1702

Mailing address

300 Professional Center Dr
Suite 311
Novato, CA 94947-4334
Phone (415) 448-1500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
10318CAMDOptometrist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073694543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PROFESSIONAL CENTER DR",
            "address_2": "SUITE 311",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949474334",
            "telephone_number": "415-448-1500",
            "fax_number": "415-892-8732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 BON AIR RD",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "949041702",
            "telephone_number": "415-448-1500",
            "fax_number": "415-461-4229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "CHERYL",
        "middle_name": "LYNN",
        "credential": "F.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "423561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenbrae, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.