Most Relevant Information
Provider Data
| NPI Number: | 1003328253 |
| Provider Name: | CELESTIAL MARIE RANDLE |
| Entity Type: | Individual |
| Taxonomy Code: | 247200000X |
| Specialty: | Technician, Other |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/27/2017 |
| Last Updated: | 10/27/2017 |
Provider Practice Location
2312 WYATT CT
FORT WORTH
TX
761193104
Practice Location Phone/Fax
| Phone: | 8179072899 |
| Fax: |
Provider Mailing Location
2312 WYATT CT
FORT WORTH
TX
761193104
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |