Individual ProviderShawnta R RandallRegistered NurseNursing Service ProvidersPractice Address4212 N 16th St, Phoenix, AZ 85016-5319(602) 263-1200(602) 236-1200PECOS EnrollmentBased on the most recent information from CMS, provider Shawnta R Randall does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1184079592Provider TypeIndividualFull NameRandall, Shawnta RGenderFemaleSole ProprietorNoEnumeration Date5/4/2016Last Updated5/4/2016Contact InformationPractice LocationPractice Address4212 N 16th St, Phoenix, AZ 85016-5319Phone(602) 263-1200Fax(602) 200-5383Mailing LocationMailing AddressPO Box 31001-0698, Pasadena, CA 91110-5319Phone(602) 236-1200Fax(605) 200-5383Provider TaxonomiesCodeDescriptionLicenseCode163W00000XPrimaryDescriptionRegistered NurseNursing Service ProvidersLicenseNUR-RN-LIC-38864Montana